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Cheryl L. Bosley, Susanne M. Miller, and Amy L. Novak, Youngstown State University

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Pre-nursing students envision the day when, as registered nurses, they will develop a care plan for an acutely ill newborn or advocate for a dying patient in a long-term care facility. The transition from student to professional involves a socialization process that can be extremely stressful for students in programs like nursing. Counseling students in the pre-program phase using aAmy Novak.jpgstrategy such as anticipatory guidance can help prepare students for expected stressors and provide them with needed time to develop healthy coping strategies before entering their major.

Stress and Socialization in Nursing Programs

ISusanne Miller.jpgn addition to the typical stressors college students experience, pre-nursing students are subjected to stress from many sources specifically related to their major (e.g., competitive admission process and trying to maintain high grades) (Goff, 2011; Jimenez, Navia-Osorio, & Diaz, 2010). Once admitted to a nursing program, students discover high levels of stress associated with clinical course experiences, caring for patients, and preparing for the nursing licensure exam (Goff, 2011; Jimenez, et al., 2010). These stressors are encountered by students as they transition or “socialize” into their new role as student nurse and experience what encompasses becoming a nurse.

Socialization is a term used in the nursing profession to describe the experience graduates encounter when first entering the workforce. It involves a process in which new nurses internalize and adapt to the norms and values within the organization (Mooney, 2007). Students entering the nursing major experience a similar socialization as they learn how to adapt to new rules and expectations. Formally, learning to be – to think and act – like a nurse, takes place during the clinical experience and in the classrooms and labs. Informally, this process occurs through interactions with faculty, advisors, and other students inside and outside the classroom. Regardless of the setting, students are likely to experience stress while adapting to their new role as a student nurse.

Nursing students often share with faculty and advisors the pressure and worry they have related to unclear clinical expectations, time-consuming clinical preparation, frustrating interactions with physicians, staff or patients, and fear of failing courses or making clinical errors. Students may be surprised to discover that not only is the grading scale higher in a nursing program, but exam questions may be different so they must learn new ways to prepare for classes and exams. Programs typically have strict policies for attendance, grading, and progression. A lack of flexibility in course and clinical scheduling means added stress for students who work or have children. Additionally, students may be unprepared for performance-type (skill proficiency) testing that requires very high or even 100 percent accuracy. Students may feel the stress of these overwhelming expectations and conforming to many inflexible rules; they may fear the consequences of nonconforming (Clark, 2008; Hall, 2004).

Anticipatory Guidance as an Advising Strategy

Anticipatory guidance is a nursing intervention used to prepare patients or family members for an anticipated developmental or situational crisis (Rakel, 1992; Thobaben, 1999). When patients know what to expect they can learn the healthy coping strategies needed to help them through a crisis. In a similar way, academic advisors can use anticipatory guidance to help pre-nursing students understand the socialization process and its associated stress. When advisors use anticipatory guidance, we allow students time to develop strategies for handing the stress in healthy ways prior to entering the major.

Anticipatory guidance involves providing realistic expectations and discussing what effect these expectations may have on students. Students may need additional time during their advising appointments or schedule additional appointments to allow time for these discussions. Resources available to students for dealing with stress should be explored during these visits.

Students may be hesitant to discuss their stress for fear that it could affect their progression. However, when students have advanced preparation and understand that stress is a common experience among nursing students, they may be more likely to engage in open communication with their advisors.

Developing Healthy Coping Strategies

In addition to facilitating student understanding of stress sources in a nursing program, it is important to help students identify healthy coping strategies. Murdock, Naber, and Perlow (2010) noted that of the 95 nursing students surveyed, more than 90 percent wanted to develop better coping skills and thought that stress management should be taught upon admission into a nursing program. Almost half of surveyed students did not feel they used good stress management skills. Students reported using exercise, socializing, listening to music, eating, meditation/deep breathing, smoking, and drinking alcohol to relieve their stress (p.8). Additionally, Jimenez,et al. (2010) observed that students’ inability to cope with the stressors associated with their academic program could affect their mental and/or physical health and academic performance (p. 453).

Offering opportunities for pre-nursing students to interact with each other can reinforce anticipatory guidance and help students identify successful coping strategies. Peers can share stressful experiences and how they coped in healthy ways. Advisors should explore creative ways pre-nursing students can make these connections with current students. Pre-nursing student organizations and student mentoring programs provide opportunities for student interaction. Peer mentors in the major also can help advise pre-nursing students on non-academic issues.

When advisors use anticipatory guidance as an advising strategy, we can help pre-nursing students understand the stressors they will encounter and learn healthy coping strategies that can be used when they enter the nursing major. Advisors working with students in other majors are encouraged to adopt anticipatory guidance techniques to help their students.

Cheryl L. Bosley
Associate Professor, Department of Nursing
Youngstown State University

Susanne M. Miller
Senior Academic Advisor
The Bitonte College of Health and Human Services
Youngstown State University

Amy L. Novak
Student Nurse
Department of Nursing
Youngstown State University


Clark, C. M. (2008). Student voices on faculty incivility in nursing education: A conceptual model. Nursing Education Perspectives, 29(5), 284-289.

Goff, A. (2011). Stressors, academic performance, and learned resourcefulness in baccalaureate nursing students. International Journal of Nursing Education Scholarship, 8(1), 1-20.

Hall, J. M. (2004). Dispelling desperation in nursing education. Nursing Outlook, 52 (3), 147-154.

Jimenez, C., Navia-Osorio, P. M., & Diaz, C. V. (2010). Stress and health in novice and experienced nursing students. Journal of Advanced Nursing, 66(2), 442-455.

Mooney, M. (2007). Professional socialization: The key to survival as a newly qualified nurse.International Journal of Nursing Practice, 13, 75-80.

Murdock, C., Naber, J., & Perlow, M. (2010), Stress level and stress management skills of admitted baccalaureate nursing students. Kentucky Nurse, April/May, 8.

Rakel, B. A. (1992). Interventions related to patient teaching. Nursing Clinics of North America, 27(2), 397-424.

Thobaben, M. (1999). Anticipatory guidance for family caregivers. Home Health Care Management & Practice, 11(4), 8-14.

Cite this article using APA style as: Bosley, C.L., Miller, S.M., & Novak, M.L. (2011, December). Anticipatory guidance as an advising strategy for pre-nursing students. Academic Advising Today, 34(4). Retrieved from [insert url here] 


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