In recent years, there has been a focus on to what extent

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1 Home Health Care Management Practice OnlineFirst, published on October 9, 2009 as doi: / Standing on One s Own Feet New Graduate Nurses Home Health Care Challenges and Work Experiences Study Home Health Care Management & Practice Volume XX Number X Month XXXX xx-xx 2009 Sage Publications / hosted at Torild Sneltvedt, RN, RNT Liv-Helen Odland, RN, RNT Venke Sørlie, PhD, RNT Bodø University College, Norway Interest is growing for information on recently qualified nurses initial meeting with working life. This study aims to shed light on recently qualified nurses experience working in home health care. The authors chose to design the study using a phenomenological hermeneutical approach with narrative interviews and text analysis. The respondents consist of a group of four recently qualified nurses. The results show that they are surprised by the many competence requirements and expectations, that they experience feeling alone, and that they also bear large responsibility. At the same time, they enjoy their work, in which they seek to influence the working conditions for their professional practice. They do experience the anxiety of not being able to cope with the challenge of nursing practice, but they are not marked by the shock of reality. Keywords: recently graduated; nurse education; experience; home health care In recent years, there has been a focus on to what extent the content of nurse education provides satisfactory relevance to the professional practice awaiting recently qualified nurses in the various practice fields. Both international (Kramer, 1974) and national studies (Havn & Vedi, 1997) have shown that the recently qualified nurse lacks competence and the meeting with working life represents a reality shock with sink or swim being the result. The study In Deep Water (Havn & Vedi, 1997) showed a competence gap in several fields associated with weaknesses in Norwegian nursing education, first and foremost connected to practice in their education. The study showed that employers to varying degrees arranged the right introduction for recently qualified nurses. After this study, and in accordance with EU guidelines, the practice section of Norwegian nursing education has been strengthened to now make up 50% of the total education. Authors Note: This study is supported by Bodø University College, Faculty of Nursing, Norway. It is part of a larger project dealing with recently graduated nurses, which includes nursing homes and surgical and medical departments. The authors are grateful to the informants and their eagerness. Correspondence concerning this article should be addressed to Torild Sneltvedt, School of Professional Studies, Bodø University College, Bodø, Norway 8049; Torild.sneltvedt@ hibo.no. Other studies show limited connection between the values presented in the Norwegian nursing education and the practice field and that the students receive little help in processing their own values (Skaug, 1994). In a British study (Gerrish, 2000), recently qualified nurses are compared in 1985 and 1999, and the study concludes that the recently qualified nurses have achieved a more active way of accessing knowledge. This is also confirmed in a Norwegian study (Wangensteen, Johansson, & Nordström, 2008). A Norwegian study concludes that about half (51%) of professionally active nurses say they are satisfied with their basic nursing education when assessing this in relation to the tasks they meet at their workplaces (Alvsvåg & Forland, 2006). Nursing students are, to a greater extent than engineers, prepared for the profession s content and tasks in that they have experience of a broad repertoire of authentic patient situations through the practice section of their education (Sæther, 2003). This study also shows that employers and nurses themselves expect to possess the necessary competence to practice their profession on completion of their education. The mix of patients in home health care has become more demanding because of users with multiple illnesses. New patient groups have also arrived, such as psychiatric patients, younger people injured in traffic accidents, 1

2 2 Home Health Care Management & Practice people with multiple handicaps, and cancer patients (Kalseth, 2004). This complexity has led to some countries to require nurses to have worked for 1 year in the field before entering home health care (Breakwell, 2004). Work is going on internationally to ensure the quality of nursing competence at the bachelor level and also at advanced education levels related to municipal health care (district nursing; Swider et al., 2006). Work is also being carried out to develop Web-based education provisions aimed at continually updating nurses in home health care (Maxwell, 2009). Design Method A phenomenological hermeneutical approach was chosen (Lindseth & Norberg, 2004) using narrative interviews and text analysis based on the suitability to the study s problem complex. Respondents Four recently qualified nurses in home health care participated in the study. The youngest was 24 years old and the eldest was 47. The average age of the group was 38 years. Selection of the respondents was carried out in cooperation with the home health care leadership involved. The criteria for selection were that the nurses had completed their bachelor degree education, either part-time or full-time, and had been at work for a period of up to 18 months. All the respondents had practiced at least 8 weeks in home health care during their education. Data Collection Method To keep the study as open as possible, and to obtain as much information as possible, we conducted narrative interviews with the nurses (Lindseth & Norberg, 2004). The nurses were asked to talk about their experience of being recently qualified nurses in home health care. In the interviews, follow-up questions were asked to acquire a deeper understanding when something remained unclear. The respondents were interviewed at locations they found suitable either at college or at the home health care offices. The interviews lasted on average 60 minutes. All the interviews were recorded and transcribed verbatim. Data Analysis The phenomenological hermeneutical method was used to analyze the interview text (Lindseth & Norberg, 2004). The French philosopher Paul Ricour inspired this method. The analysis involves dialectical movement between the partial and the whole and is carried out in three stages: 1. Naive reading of the interview to gain an allround understanding. The text is read with an open mind to gain an impression of how the recently qualified nurse experiences the meeting with working life in home health care. At this point no effort is made to carry out analysis, but an impression of the tendencies in the material is created. 2. Structural analysis in which one separates the text into meaningful units consisting of a part of a sentence, a whole sentence, and sometimes several sentences. The meaningful units are then condensed and discussed between the authors to identify themes and subthemes. In this process, the impressions from the naïve reading are either confirmed or rejected. 3. A comprehensive understanding is developed, building on the first naive reading, the structural analysis, and the new read-through, in which understanding is expanded through use of relevant theory and previous research. The data analysis focuses on studying the meaning of living experience and sets aside what we think we know about being recently qualified in home health care. Instead, we focus on the meaning of what the recently qualified nurse has said, and how the view of this experience is formed. Ethical Considerations The nursing leadership gave permission for the study to be started and delivered respondents. All participants gave their informed consent before taking part in the study and knew they had the option to withdraw at any given time. All the information has been made anonymous and has also been handled confidentially. Each respondent gave permission for the conversation to be recorded. The recordings will be deleted after the study has been published. Result The themes and subthemes from the second-stage structural analysis are presented in Table 1. Statements given by the interviewees will be cited under the appropriate themes and subthemes.

3 Sneltvedt et al. / Standing on One s Own Feet 3 Table 1 Themes and Subthemes From the Interview Text Themes Unexpected and surprising nurse role Responsible nurse role Thriving in the role of nurse Framework conditions for the nurse role Subthemes Meeting many different competence requirements Seeking knowledge Meeting various different expectations Being alone Bearing large responsibility Feeling proud Feeling looked after Relating to regulations Obtaining influence Unexpected and Surprising Nursing Role A major theme in the recently qualified nurses narratives is that the transfer from being a student to being a nurse was characterized by surprise at being met with so many different competence requirements as well as being met with many expectations of both a professional and a nonprofessional nature. The role change from being a student to being a nurse involves a certain fear and feeling of humility in relation to the new role. Even if nursing education contains 50% practice in which a period of 8 weeks is completed in home health care, the nurses still experience not being completely prepared for how it is to be a nurse. The transfer from being a student is expected and desired, but when it arrives it is experienced as surprising and strongly defined. I got the job and was going to start being a real nurse. Bearing the responsibility, I was more afraid and humble because of being new. Meeting many different competence requirements. The field is described as complex, more or less as a synthesis of the whole professional field. The respondents describe meeting all age groups, drug addicts, alcohol abusers, psychiatric patients, cancer patients, stroke patients, diabetes patients, dying patients, and patients only needing eye drops. There are many challenges requiring the nurses to be able to master everything from advanced acute medicine to meeting loneliness in the homes of people living alone with very varying social networks. Home health care is quite multifaceted and diverse. We have to take the area I have been in for the last 1½ years. Here we are placed with a lot of young people. This means we have had a lot of sores. We have had a lot of cancer cases with palliative treatment and terminal care. It is clear that here we do meet some nursing challenges related to this. Suddenly they come with CVK and vein ports. Liquid balance. Nutrition. A lot of practical procedures. I went down to the hospital to get some more training. The nurses describe their work day as requiring not only action competence related to, for example, procedures and acute medicine but also relational competence. This competence will enable the recently qualified nurse to meet people in different life situations with varying degrees of care requirements. Seeking knowledge. The study shows that nurses actively seek knowledge to meet the many various competence requirements. The following statement confirms this: Therefore I went and started sitting in with the specialist health service. Voluntarily and without salary. Just because I felt I was not up to it. I was afraid. I knew that that was something I thought to be difficult. The narratives show that the recently qualified nurses do meet the challenges of meeting people in various degrees of crisis. Here the narratives also show that they reckon their age and experience as a resource. And right then I am pleased that I am an adult, and not just a 20-year old coming. That you do bring that with you despite being new. I am 47. It provides safety that you dare more because; even though you feel you don t possess the knowledge you should well enough... The recently qualified nurses do not give the impression of being very critical in relation to their education and how this has prepared them for the professional role of being a nurse. They assess the theoretical subjects as important in relation to practicing their profession. This applies to nursing subjects and ethics. They say that they, in some contexts, did not see the relevance of the education during the education itself but that they could put the knowledge into context after practicing a while in the profession. The nurses see the limitations of the theoretical attainment of knowledge and value experience as a major source of building up one s own competence. Theoretical

4 4 Home Health Care Management & Practice knowledge is important, but it is experience that gives security. Yes to the knowledge. We would have to have done another year at the nursing college, to get more practice. Because this knowledge we have to gain through more hours of practice. Practice with people, we can read and read at home, but the nursing profession is about converting theory into practice. It doesn t help reading about sores and sore treatment of diabetes, if we do not see it. We have to see a sore to see how it can be prevented. And to treat a sore you have to have the theory and the theorists. The ethics. Meeting different expectations. The average age among newly qualified nurses is 38 years. One of the respondents is in the early 20s and is met with unbelief because of the young age. The worst thing about being newly qualified and young is that people do not really believe in me. Because I look very young and unqualified, as many will call you in home health care. I do meet some unbelief. But I just have to know that I can do it, and if I can t do it, I just have to look it up and come back to it.... that home health care and nursing has become older men and women and not young girls coming home and nursing. Not many older people think that young girls can be nurses... so that is stupid, because what can I say back to those who are skeptical. Home health care nurses meet expectations from users, which are not necessarily related to the nursing profession. These expectations can be about the loneliness of users with limited or even no human contact outside the home health care service. Users can also be manipulative by wanting home health care nurses not to set limits to what their tasks are, and rejecting those who do limit themselves to professional nursing. Some of us do not befriend the users. It is not my job and then I would get the cards mixed up, I feel. Hang up curtains and clean the house. That s not my job. One example, but it could be so many things. And then it goes on... it all gets out of hand... you come in to a user... no, is that you coming today? I want this and that person, for she is like this and that... It is a little bit like that... A conflict can start. It is unpleasant or pleasant compared to those who do everything, and who do things they re not supposed to do... It is a bit of a dilemma. Work in home health care requires awareness of what a home health care nurse s tasks are and what are not. The nurses have to take a stance regarding what the professionally based tasks are and what is pure service falling outside the nurse s field of work. They must set limits to what their professional duties are and not just perform what the users ask for. Users, for their part, may well have real care needs, which they experience not being covered. The narratives show that some users attempt to control the situation by separating between the kind and the nasty nurses. The latter are those who set limits to what sort of tasks they should perform. Responsible Nursing Role Being alone. Nurses tell about their experience of work in home health care as being a lonely job in which nobody shares responsibility with them in the situation. There is something about working in home health care nursing. We stand alone with the responsibility. We do not have a bell to ring beside us: you must come and help me. We have to think for our self and we must act, based on the situation and what the situation requires there and then. Daily, nurses meet complex challenges, which they have to tackle alone in the homes of users without support being available from colleagues. I am still new myself and have been there for just a while. Perhaps I do not understand that he is as ill as maybe the next nurse thinks, who gets the person concerned admitted to hospital. That it was that serious. And if you are with the user the whole time as in hospital, you get to see him the whole day for several days. I just get into a muddle one moment and then I don t see it the same way. I don t know the person either. It may be like this. It happens all the time. The respondent feels the responsibility as it takes a long time before work colleagues discover if she has made a wrong evaluation of a patient s condition. It is easy to make wrong evaluations if you do not know the patient and do not have enough time to make an evaluation. She recognizes that the user may suffer for a long time before he or the next home health care nurse approaches her.

5 Sneltvedt et al. / Standing on One s Own Feet 5 Bearing a big responsibility. Home health care nurses experience the responsibility as big and that they to only a slight degree have others to support them in the situation at home with the users. The responsibility of standing on your own feet and having to trust your own judgment weighs heavily on the recently qualified nurse. This was new the group of patients. It was new to have a role which was so serious. We are talking about people who were ill and if we did something wrong, then we didn t get too many more new chances... something catastrophically wrong. Thriving With the Role of Nursing Nurses have positive feelings about being in home health care nursing and feel pride in being a nurse. Feeling proud. The best, no, this must be being a nurse. Yes. I have become fond of being a student. I have become adult and thought it was really enjoyable. Miss being a student quite often, because it was fun to learn something new. But I think it was to become a nurse. The pride, which followed. Being able to offer something. I cannot really say it has been that bad. I have enjoyed it. Very happy and proud of the job. They experience that they master the complex working day in home health care and feel great satisfaction with this. Yes, I was glad because now I could do it. Yes, I was going to test myself a bit and get the feeling of having responsibility and now you have to show what you have learned. Wearing the badge on which it says nurse is a big thing for me. For some people it may not be, but for me it was really big the day I could take off the badge saying I was a student. The first day was incredibly big. I have completed. I am a qualified nurse. Being looked after. They thrive at work and are looked after by colleagues. But home health care was nearly like coming home to something. They were so incredibly welcoming and glad that I came, as if they lacked people or whatever it was. I felt so looked after by everyone. Very pleasant the whole gang. They helped me get a very positive impression of the environment and the workplace. I was so included. I have experienced that I was not included in many practice periods. It was just her the student. Had no name. For one person it looks, however, like there is a lack of being looked after and feedback. The working colleagues think wrongly that she has been there previously as a student and that she knows the zone. It is my job. I have not heard anything yet. But that is what I think, I was left a bit alone at the beginning, and had to really get a grip. I was not here on my student practice. But they recognized me, as if I had been here previously. The respondents have to varying degrees received introductory programmes for new employees. Framework Conditions for the Role of Nurse Relating to regulations. The home health care service is organized by way of quantitative management tools regulating what sort of service the user gets and what amount of time in minutes this should take. In any case we have a system called Budda as a base. In this Budda system it is Budda who distributes the resources. So the distribution office tells me that if I am going to put in a catheter in the bladder, this will take 10 minutes. For Budda says that it takes 10 minutes to put in a catheter. It goes without saying that this is impossible. So they put the regulation in then. If you are going to give someone a shower you get 30 minutes. You don t need any time to undress, shower, and dress again. One of the nurses wants to help a lonely user to get out of the house, and she asks the nursing service for the allocation of more time to take care of social needs but receives a negative reply. She is frustrated but accepts the answer. Then there are not enough resources. We do not treat loneliness. I have asked for this and been given an answer. I have raised this issue. Because I think that sometimes we could have got the goahead to take them out for a walk for example. The recently qualified nurses have limited freedom to practice professional judgment in the situation, but they

6 6 Home Health Care Management & Practice do relate to the framework conditions decided on for the visit to the user s home. This limited professional freedom to take appropriate action over and above the decided on framework frustrates them, but the recently qualified nurses react differently to this. All of them describe having influence through weekly meetings in which the decisions are discussed and evaluated. Some of the nurses are more active and attempt to gain more control over their own work situation, whereas others more or less subjugate themselves to the system. It is clear that when a spokeswoman was going to be elected they were quick to ask me because I open my mouth and say things the way they are. I think it was great today when I got to hear that they got more people and yes very proud of this. What I achieved. It helps. It really does. Recently qualified, yes, but here it is all about being adult and taking responsibility on the job. And then you learn from this. Methodological Assessments Validity in qualitative research can, be threatened by elite bias. This means that the respondents who let themselves be interviewed are often the most articulate and successful people in a group. The recently qualified nurses, who do not master the challenges of home health care, will probably leave the workplace quickly. They are therefore not covered by this study. Discussion The narratives are about growing into a professional role to meet requirements that surprise and overwhelm. The requirements to professional competence are extensive and complex in home health care, and the fresh professional must, during the working day, adapt to very different user groups. This covers young users with drug and alcohol addiction and psychiatric problems, lonely older people, and users with the need for advanced medicinal treatment. Therefore, they meet, over the whole spectrum, big competence requirements related to extensive and complex care needs. Nursing education in Norway consists of 50% practice, and at least 8 weeks of this practice is to be carried out in the home health care service. This means that the recently qualified nurse has gained authentic experience from the field. Both employers and the recently qualified nurse expect to possess the necessary competence to practice in the field (Ramritu & Barnard, 2001). The narratives show that the nurses experience the role of nurse as being different from the role of student nurse and that they are overwhelmed and surprised on entering professional life. This is also confirmed in other studies (Havn & Vedi, 1997; Kramer, 1974). They do not, however, describe this as a practice shock. In some countries, it is required for recently qualified nurses to have at least 1 year s experience from work in the health sector before being employed in home health care (Breakwell, 2004). The increasing complexity as a result of new user groups with complex needs provides a multifaceted, varied work field, which is difficult to grasp. This can in turn suggest a requirement for 1 year s work experience before employment in the health home service or alternatively that the education and municipal health service cooperate on preparing students for future work in home health care nursing. The recently qualified nurses say that they relate actively to the complex requirements and that they themselves take the initiative to acquire more knowledge, often without financial or other support from employees. This active way of relating to the extensive and complex challenges among recently qualified nurses is confirmed by national and international studies (Gerrish, 2000; Wangensteen et al., 2008). In home health care, the nurses experience not only both extensive and complex professional requirements but also requirements from users that are not necessarily of a professional nature. In the narratives, it is described that users often ask the recently qualified nurse to carry out tasks over and above what has been agreed on. They prefer the helpers who are willing to go far in meeting their demands. The recently qualified nurse is especially challenged to limit his or her professional practice through taking a stance about what is professionally legitimate and necessary to use time on. The service is organized through decisions that concretely lay down that there is 10 minutes available, for example, for sore treatment or 30 minutes for user showers. This gives the nurses less professional freedom and at the same time represents a certain limitation of the professional role. It looks, however, as though the more informal systems also kick in here with the users asking for services not based on regulations. The recently qualified nurse constructs his or her professional and moral identity in working life by making choices in relation to getting involved with the users need requirements. They need support from their employer and professionally skilled role models in the work to fulfill and also limit their own professional role. Growing into their professional role as a nurse in home health care is described as a lonely process in that the professional works alone in the users homes and has

7 Sneltvedt et al. / Standing on One s Own Feet 7 to take decisions in situations with only limited colleague support and guidance available. They stand on their own feet in a work situation characterized by little work experience and a lot of responsibility. The recently gained status of nurse implies vulnerability in relation to mastering all the complex challenges present in home health care nursing. The nurses feel this big responsibility that they carry. Responsibility is a key concept in ethics. It is directed at other people and the challenges arising when these people are vulnerable and dependent. The more vulnerable and dependent one is on other people, the stronger the moral responsibility, and one cannot avoid taking this responsibility by referring to the framework conditions imposed by working life. Being conscious of this ethical and moral dimension in practicing one s profession is as important as the nurse taking care of herself or himself. Then she or he will be able to develop the best of herself or himself and thrive in a job over a long period and develop skill and professionalism in work practice (Henriksen & Vetlesen, 2000). In the home health service nurses mostly work alone and therefore bear the responsibility alone for, for example, making the correct observations, good and appropriate evaluations, and taking action. Professional practice in the home health service seems to offer freedom in relation to standing on one s own feet and this in turn leads to nurses thriving. This means that nurses manage to grow on the big responsibility they experience. The narratives show that the recently qualified nurse does thrive in working life, which is also confirmed by other studies (Wangensteen et al., 2008). Other studies show that the recently qualified nurse goes through a process in which he or she either sinks or swims on meeting working life. This is a brutal process that some master, whereas others fail in the professional role. The respondents narratives describe positive feelings such as enjoyment and the pride of being a nurse. This may be the pleasure of mastering something demanding and being someone who swims rather than sinks being expressed in pride and pleasure. The positive experience may also be connected to the respondents mostly being adult people with other professional experience these respondents have chosen a professional career based on a strong wish to become a nurse, and this provides motivation and commitment. The feeling of thriving may also be related to the active way the respondents associate to the professional challenges. In the narratives, an inclusive work environment is also described in which the recently qualified nurse feels taken care of in spite of mostly working alone in users homes. The recently qualified nurses in the home health service have a high average age, and they have work experience and experience from private care tasks. They consider this to represent resources helping them to adapt and also to gain the pride and pleasure they express. The nurses in the home health service say that the meeting with professional life is also about a meeting with economically oriented management tools in the form of regulations about what is to be carried out with allocated minutes for each task. They have to relate to these regulations decided on at middle management level. Professionalism and the fresh professional s integrity in the process of development are challenged on meeting the economic framework conditions. The professional freedom to take action is limited by strong management in the form of regulations. The recently qualified nurses narratives show various ways of relating from subjugation to actively fighting to gain influence through the spokeswoman/spokesman system. The recently qualified nurse is challenged between the system and professional loyalty to his or her work in which he or she creates his or her own professional and moral identity. The nurses stand in a situation in which they have to choose what sort of nurse they want to be and what kind of values they want to defend in a complex, hard to grasp, and demanding field of nursing. They say that actively obtaining influence on their own work situation through formal channels is related to their professional commitment and leads to them thriving. Conclusion The recently qualified nurses in home health care work alone in the homes of users, facing extensive competence requirements. The fresh professional practitioner must stand on his or her own feet and must to some extent mark up his or her own course with regard to how the professional role is to be practiced. Growing into the professional role seems to offer positive experience in the form of a feeling of thriving, pride, and mastery. The professional role is practiced in a system of managed framework conditions in the form of regulations providing limited freedom to choose what sort of nursing procedures are done. Action has to be taken for the user in his or her home. The nurses do experience, however, a certain degree of influence, and some are active in influencing the economic framework conditions for professional practice. For recently qualified nurses, practice hits them as a professional and human challenge. They experience the fear of being inadequate but also experience the feeling

8 8 Home Health Care Management & Practice of thriving in a challenging and responsible professional practice. References Alsvåg, H. (2006, September 22). Nursing education in light of new RNS`professional experiences. Nursing Science and Research in the Nordic Countries, Breakwell, S. (2004). Connecting new nurses and home care. Home Health Care Management Practice, 16, Gerrish, K. (2000). Still fumbling along? A comparative study of the newly qualified nurse s perception of the transition from student to qualified nurse. Journal of Advanced Nursing, 32, Havn, V., & Vedi, C. (1997).In deep water- recently graduate nurses competence in somatic ward. Trondheim, Norway: SINTEF- IFIM. Henriksen, J.-O., & Vetlesen, A. J. (2000).Closeness and distance. Foundation, values and ethical theories in working with human beings. Oslo: Gyldendal akademisk. Kalseth, B. (2004). Development in community health care and specialist health care- tasks and cooperation. Oslo, Norway: SINTEF Unimed. Kramer, M. (1974). Reality shock; why nurses leave nursing. Saint Louis, MO: C. V. Mosby. Lindseth, A., & Norberg, A. (2004). A phenomenological hermeneutical method for researching lived experience. Scandinavian Journal of Caring Sciences, 18, Maxwell, S. M. (2009). WebQuests: A viable solution to meeting the continuing professional education needs of home health care nurses. Home Health Care Management & Practice, 21, Ramritu, P. L., & Barnard, A. (2001). New nurse graduates understanding of competence. International Nursing Review, 48(1), Sæther, E. (2003). From novice to proficient practitioner or theorist without practitional insight? Nursing Science & Research in the Nordic Countries, 23, Skaug, E.-A. (1994). Nursing identity-a study of the characterization of Nursing identity and how nursing students recognize the Nursing discipline. Institutt for sykepleievitenskap, University of Oslo, Oslo Swider, S., Levin, P., Ailey, S., Breakwell, S., Cowell, J., McNaughton, D., et al. (2006). Matching a graduate curriculum in public/community health nursing to practice competencies: The Rush University experience. Public Health Nursing, 23, Wangensteen, S., Johansson, I. S., & Nordström, G. (2008). The first year as a graduate nurse An experience of growth and development. Journal of Clinical Nursing, 17, Torild Sneltvedt graduated in nursing science and is an assistant professor in the Faculty of Professional Studies, Bodø University College, Norway. She teaches the following subjects: nursing science, ethics, supervision of practical training in elderly care, and nursing home care. She is a coauthor of Nursing Ethics: Textbook for Education in Nursing and Health Care. Liv-Helen Odland graduated in nursing science and is an assistant professor in the Faculty of Professional Studies, Bodø University College, Norway. She teaches the following subjects: nursing science, ethics, supervision of practical training in elderly care, and nursing home care. She is a coauthor of Nursing Ethics: Textbook for Education in Nursing and Health Care. Venke Sørlie is a professor in the Faculty of Professional Studies, Bodø University College, Norway. Her research includes municipal health and care service, care for the elderly, ethics, and children with cancer.