A POWER EXPERIENCE: A

PHENOMENOLOGICAL STUDY OF
INTERPROFESSIONAL EDUCATION
JOYCE ENGEL, PHD, M ED, B ED, RN DIPL*, DAWN PRENTICE, PHD, MS, BSN,
KARYN TAPLAY, PHD, MSN, BSCN

AND

The purpose of this supplementary analysis of a hermeneutic phenomenological study of the

experience of interprofessional collaboration for nursing and medical students was to explore
the experience of power that was threaded throughout the original study. Seventeen students
participated in guided, face-to-face conversations in the original study (Prentice, Engel, Taplay, &
Stobbe, 2014). Through the processes of deductive analysis and inductive reasoning, 2 themes of
power emerged from these research conversations: (a) complicated knowledge is power and (b)
the power and silence of intimidation. These themes suggest that power and power differentials
are significant factors in student interactions in interprofessional learning and have the potential
to adversely affect these interactions. Students' perceptions of power need to be taken into
account and addressed when planning and implementing interprofessional education events. (Index
words: Nursing students; Medical students; Interprofessional education; Qualitative research) J Prof
Nurs 0:18, 2016. 2016 Elsevier Inc. All rights reserved.

NTERPROFESSIONAL COLLABORATION, DEFINED

as a partnership between a team of health professionals
and a client in a participatory, collaborative and coordinated approach to shared decision-making around health
and social issues (Orchard, King, Khalili, & Bezzini, 2012,
p. 58), has been widely accepted (Engel & Prentice, 2013;
Prentice et al., 2014) as a means to achieve holistic,
patient-centered care (Corser, 1998; Engel & Prentice,
2013; Hart, 2015). In order to achieve this aim,
interprofessional competencies have been developed
with the implicit expectation that leveling of power
and status (Hart, 2015) will enable symmetrical relationships (Corser, 1998) where decision-making around
patient care is positioned in experience and knowledge
rather than in functions and roles (D'Amour,
Ferrada-Videla, Rodriguez, & Beaulieu, 2005). The inculcation of these interprofessional competencies has been tasked
Associate Professor, Department of Nursing, Brock University, St.
Catharines, Ontario, L2S 3A1.
Chair and Associate Professor, Department of Nursing, Brock
University, St. Catharines, Ontario, L2S 3A1.
Assistant Professor, Department of Nrusing, Brock University, St.
Catharines, Ontario, L2S 3A1.
Address correspondence to Dr. Engel: Associate Professor,
Department of Nursing, Brock University, St. Catharines, Ontario, L2S
3A1. E-mail: jengel@brocku.ca, engeljoyce@gmail.com (J. Engel),
dprentice@brocku.ca (D. Prentice), ktaplay@brocku.ca (K. Taplay)
8755-7223
Journal
1
of Professional Nursing, Vol 0, No. 0 (September), 2016: pp 18
2016 Elsevier Inc. All rights reserved.

to interprofessional education (IPE), although there is little

evidence to suggest that IPE has had any permanent impact
on the eventual practice of graduates (Prentice et al., 2014;
Veerapen & Purkis, 2014).
Interprofessional collaboration occurs best within an
environment where there is a high level of trust, which
arises out of valuing both the contributions of one's own
professional expertise and the professional expertise of
others (Orchard, Curran, & Kabene, 2005). Trust
involves respect and conviction that others are acting
with moral intent, and trust is facilitated by understanding the roles and knowledge that each member of a
profession can bring to patient care (Orchard et al.,
2005). When roles are understood and valued, there is
trust that expertise can be shared and situated to best
serve the needs of the patient (Orchard et al., 2005).
Orchard et al. (2005) outline barriers to interprofessional collaborative practice such as organizational
structures, which include regulatory requirements and
funding structures, such as health insurance. These
structures have established and maintained hierarchies
that impact relationships within and between organizations, health professionals, and patients (Orchard et al.).
In addition to organizational structures, Orchard et al.
suggest that the socialization of professionals into the
ways and thinking of their disciplines can create power
imbalances and pressures on health professionals to
behave in ways that are not collaborative.
1
http://dx.doi.org/10.1016/j.profnurs.2016.08.012

ARTICLE IN PRESS

Power has been conceptualized in a variety of ways (Clegg,

Courpasson, & Phillips, 2011) but essentially is a socially
constructed dynamic that shapes what we can or cannot do
and the decisions and choices that we are allowed to make.
Simply put, power determines what privileges are
granted (Clegg et al., 2011) and under what circumstances authority is exercised. Power is essentially
relational in that it exists in and between people, as
evidenced in interprofessional relationships that determine how collaboration or shared power is enacted. The
basis of influence in relationships has been attributed to
various factors such as knowledge or the willingness of
individuals to bend their wills to a particular purpose (Clegg
et al., 2011). For example, Foucault (1977, 1980) suggested
that knowledge was critical in establishing power in that
dominant regimes determine what is truth and rationality,
which serves to privilege or to marginalize persons, an idea
that is supported by Coburn's (2006) analysis of the
dominance of the medical profession. In addition to
knowledge, Max Weber (1978) posits that legitimate
influence exists necessarily because others accept it,
which Coburn points to when he suggests that medicine
was effective in persuading the public and others of its
value and importance.
Relationships, perceptions, and behaviors related to
power may result from sociohistorical factors that shape
how persons select careers and how they view certain
professions (Adams, Hean, Sturgis, & Macleod Clark,
2006; Price, Doucet, & Hall, 2014). Price et al. (2014), in
a literature synthesis related to the history of the nurse
physician relationship, suggest that negative comparisons
of nursing with medicine, which remain as central
professions in patient care, begin even as individuals
are considering career paths. Plagued by stereotypes that
reflect traditional, 19th century roles for women (Hall,
2005), nursing is seen to embody values and behaviors
such as submissiveness to authority, selflessness, and
obedience (Hall, 2005; Keddy, Gillis, Jacobs, Burton, &
Rodgers, 1986; Price et al., 2014) and to lack the
intellectual rigor necessary to acquire or to implement
knowledge-based practice (Keddy et al., 1986; Price et al.,
2014). Price et al. (2014) suggest that nurses have
occupied a caring and moral role in patient care that
persistently remains subordinate to that of physicians
who, historically, have been the overt decision makers in
patient care. Because of the demanding decisions that
physicians are required to make, medical students have
been seen to possess the high intellectual capacity that is
necessary to be successful in difficult university programs. The power of these sociohistorical stereotypes
affects not only recruitment of students to programs but
also the socialization of students within the discipline and
in the clinical environments, where they likely encounter
individuals who have been similarly affected by sociohistorical influences (Price et al., 2014).
Despite the efforts of IPE to ameliorate the hierarchal
status of nurses and physicians and to build collaborative
skills, the effects of IPE may be short lived once students
enter practice as graduates. A recent study by Veerapen

ENGEL ET AL

and Purkis (2014) suggests that interprofessional collaboration skills acquired during educational programs
quickly dissipate in the workplace because of intergenerational conflict and lack of valuing nursing contributions by physicians. Dominance in patient care and
hierarchical roles are legitimized by physicians because of
their responsibility for overall decision making in patient
care, length of training, and considerable financial investment (Baker, Egan-Lee, Martimianakis, & Reeves, 2011).
Findings of the study by Baker et al. (2011) confirm that the
socialization of physicians and other health professionals
influences professional identities and how power is enacted
within collaborative practice teams.
Despite implicit indications that power dynamics are
involved in interprofessional collaboration, there is limited
and superficial exploration of this concept in IPE (Baker et al.,
2011). The tendency in studies of IPE over the past 30 years,
especially those involving prelicensure programs, has been to
focus on program development and outcomes of IPE
(Paradis & Reeves, 2013; Thistlethwaite, 2012); few have
involved student experiences of interprofessional collaboration and relationships or perceptions of other professions. Those available suggest that medical students tend to
see nurses and nursing students as caring (Carpenter,
1995; Rudland & Mires, 2005), dedicated, good communicators, and do gooders (Carpenter, 1995), who possess
less positive social status and are less academically able
(Rudland & Mires, 2005). Nursing students saw
medical students as decisive, detached, and arrogant,
whereas medical students saw themselves as caring and
confident (Carpenter, 1995). In a study involving Polish
medical students, Marcinowicz et al. (2009) found that
medical students valued technical skills, professional
reliability, and friendliness in nurses. Performance of
activities that were ordered by physicians was rated more
highly in nurses than autonomy or independence in
nursing practice. The findings of this and other studies
suggest that dimensions of power such as domination,
decision-making responsibility, autonomy, and intellectual
superiority are associated with the professional identity of
medicine, a socialization and identity process that may
begin informally as early as childhood (Price et al., 2014).
Professional identity affects interprofessional relationships and, subsequently, the quality of care (Khalili,
Orchard, Spence Laschinger, & Farah, 2013). From this
perspective, it is important to explore how and when
aspects of identity, such as power, are first manifested and
how it influences and is influenced by IPE. At present, there
is a gap in the literature related to perceptions and
enactments of power among students that might affect
learning together and, later, their practice as graduates.
In a recent study by Prentice et al. (2014), the
experience of interprofessional collaboration among
undergraduate nursing students and medical students,
who had been involved in joint educational events, was
explored. The major findings suggested that the students
experienced a great divide (p. 3) and that learning
means content (p.3). Students in the study tended to
remain segregated by discipline, in already-established

INTERPROFESSIONAL EDUCATION

ARTICLE IN PRESS

social relationships and experienced a level of uncomfortableness that required assistance in breaking the ice (p. 3).
This article represents a supplementary analysis (Heaton,
2004) of the research conversations from this original study.
The supplementary analysis involves a more in-depth focus
on power, a noteworthy undercurrent in the themes
identified in the primary research. This article explores
more closely the experience and meaning of power related to
the IPE experiences of the participants in the study and
identifies two themes.

Methods
The primary hermeneutic phenomenological study used
the methods described by van Manen (1997). These
guided methodological decisions in the initial study and
in the supplementary review of the research conversations, which explored the undercurrent of power that was
revealed in the original study.

Sampling
A convenience sample of prelicensure undergraduate
students from a 4-year baccalaureate program and
medical students from a nearby university were recruited
for this study. Year 3 and year 4 nursing students were
recruited because exposure to formal IPE events occurred
after their second year in the program, whereas the
medical students were involved in IPE events as early as
year one. The seven year 3 and year 4 nursing students
and ten year 1 and year 2 medical students who
volunteered for the study had all completed at least one
clinical rotation and had attended at least one or more
IPE events such as disease-oriented workshops (e.g.,
late-stage renal failure) and learning simulations. Students were invited to participate in the initial study
through Web-based invitations and word of mouth and, if
interested, were asked to directly contact a research
assistant (RA) in order to maintain confidentiality.

Data Collection
The RA, an experienced registered nurse, who had not
been involved in the interprofessional sessions, conducted research conversations with the students. Prior to
beginning the research conversations, the purpose and
structure of the conversations were reviewed with the RA
in order to ensure that the interactions with participants
were consistent with the research methodology. The
conversations, conducted during 2012, were guided by
five questions that inquired about the participants'
understanding, expectations, experience of the interprofessional learning sessions, and about how these sessions
would inform their future practice. Where appropriate,
techniques such as rewording, clarification, and summarizing were used to achieve greater depth in the data.
These conversations were transcribed verbatim and then
numbered. The transcripts were regularly reviewed
between the RA and two of the researchers (DP and JE)
to ensure that the conversations were sufficiently
unstructured to be consistent with the approach of
hermeneutic phenomenology and to uncover possible

biases or assumptions by the RA that might influence the

research conversations. The transcribed research conversations were entered into QSR International's's (2012)
NVivo 9 qualitative software for storage and organization.

Data Analysis
During the secondary analyses of the research conversations,
the main study authors (JE, DP, KT) independently
reviewed each transcript and clustered sentences and
phrases that were salient to power. Through the processes
of deductive analysis and inductive reasoning, consensus
was achieved as to the two primary themes that emerged
from the data.

Ethics
The research ethics boards for the two universities that
offered the nursing and medical programs approved this
study. Written consent was obtained from all participants, who were informed that they could withdraw from
the study at any time. Participants were reminded that
involvement in the study could, in no way, affect their
academic standing in their programs.

Results
The two power themes that emerged from nursing and
medical students were as follows: (a) complicated knowledge is power and (b) the power and silence of intimidation.

Complicated Knowledge is Power

Within the study, the disciplinary identity of the participants
was obvious; it emanated from a pervasive experience of
relative power. It was evident that knowledge and education
were important benchmarks of the competence and worth of
other participants, both within the immediate collaborative
education experience and in relation to the roles that were
expected and would be adopted as professionals.
For the nursing students, it was clear that the medical
students were perceived as both smarter and in
possession of greater amounts of complex knowledge.
The differences in knowledge set up a gap between the
two groups of students, collectively and individually.
This gap was expressed as a divergence between what was
straightforward and familiar and what was considered
complicated, challenging and, perhaps, even unattainable. In reference to how future educational events might
be changed to be more meaningful, for example, one
student suggested that they needed to include information that nursing students could better understand;
something that was less scientific, simpler, and reflective
possibly of what was seen as the less demanding and
vigorous nature of nursing knowledge.
Something really simple and not complicated
something nurses would know better, not like pure
anatomy. (Participant 14, nursing student).
The divergence in knowledge that emerged was not
only about which knowledge background was more
difficult to understand or obtain, but was also about the

ARTICLE IN PRESS

ENGEL ET AL

types of knowledge that each brought to their IPE

experience. The knowledge base of the nursing students
was seen as skill-based, practical knowledge that was
influenced by what both groups acknowledged as the
nursing students' greater amount of clinical experience.
For medical students, the knowledge that nursing
students and nurses had was valued in the everyday,
operational activity of patient care, where medical
students depended on nurses and nursing students to
help them navigate an unfamiliar environment. The
language of the medical students suggested that what
nurses and nursing students know is doing, which calls
back to what Price et al. (2014) propose is the strong
vocational legacy that has been associated with nursing.

the value of what the nursing students brought to

interprofessional collaboration or perhaps a sense that
their contribution was somehow less than what the
medical students were able to bring. It is a language of
limitation.
For some nursing students, it was important to minimize
or reduce what they perhaps experienced as a limitation in
or as a gap between their knowledge and that of the medical
students by emphasizing similarities between what they
and the medical students knew. The highlighting of
similarities implies that there was an awareness of
difference that needed to be overcome or minimized.
Medical students' assessments were very similar if not the
same as the nursing students' assessments.

We are very dependent on them [nurses] to tell us

where we need to stand orwhat do we do?
(Participant 9, medical student).

I thought it would be in much more depth, but it

was very, very similar. (Participant 5, nursing
student).

Although the medical students acknowledged the

practical knowledge of the nursing students and nurses
as important in specific situations, such as learning how
to chart perfectly and communication (Participant 13,
medical student), there was disparagement about the
weakness of the nursing students in relation to scientific
knowledge.

The effort of nursing students to align their knowledge

and program with that of medicine suggests that the
knowledge and thinking of medical students was
desirable to them. Desirability accords power and, thus,
status that emerges out of having what others perceive as
important or of significance. For some nursing students,
this meant that having knowledge similar or even
identical to that of medicine was something to be sought
after. One nursing student expressed the value of IPE as
the opportunity to acquire medical rather than health
care or nursing knowledge and, perhaps, as an opening
through which to glimpse information that might
otherwise be unavailable to those who were positioned
lower in what Price et al. (2014) terms as a social
hierarchy (p. 105).

Someone doesn't even know where the kidney

is(Participant 13, medical student).
While this statement may have simply meant that there
was limited awareness about what nursing students learn,
it nonetheless implied deficiency in areas of knowledge
that medical students considered important and perhaps
more valuable than that of nursing students, which was
more practically based and lacked the rigor of anatomical
or complex scientific knowledge.
Perhaps, too, there was implication that practical work
does not require knowledge, and thus, those in nursing
lacked the intellectual curiosity to acquire further
knowledge. The type of knowledge that the nursing
students were seen to possess may be similar to what
Heidegger (1992) suggests is ready-to-hand knowledge,
which is primordial, contextual, and nontheoretical.

By contrast, several medical students attempted to

widen the knowledge distance between themselves
and the nursing students by pointing to the
leadership and superior problem solving that
medical students exhibited in shared learning
experiences. It was a problem solving thing but it
was largely myself and the other medical students
who were kind of doing it. (Participant 15, medical
student).

We are in third year and maybe more clinically

experienced than they so there were some things that
we were able to bring. (Participant 6, nursing student).

The experience of widening and narrowing distance

between team or group members suggests recognition of
power. Distance between individuals is increased when
there is an enhanced awareness of inferiority and
superiority or, put in another way, when the meaning
of relative power is grasped (Hofestede, 1980; Rieck,
2014). Within the interprofessional learning experience,
the alignment or separation of knowledge and thinking
skills suggested students' appreciation of the power
differences between medicine and nursing, differences
perhaps socially constructed, either while in programs or
perhaps prior to entrance.

There is tentativeness in the use of some by Participant

6 (nursing student), which implies an uncertainty about

Within the world in general, people with education

are seen as more to say a higher social status

Doctors are looking up things on their phones,

more so than nurses, because nurses are doing roles
that are more practical. (Participant 3, medical
student).
For some nursing students, there was acceptance that
their knowledge was restricted, less powerful in its
influence.

INTERPROFESSIONAL EDUCATION

ARTICLE IN PRESS

sounds so primitive but you look at them [doctors

and medical students] differently. Their profession
has more power than you do, you know, more
education. (Participant 1, nursing student).
While differences in education and knowledge were
important in the assignment of status and power, so, too,
was the process of admission to the programs. Gaining
entrance to medicine implied that those who were
admitted were the brightest and most capable and, thus,
were superior to those who were not. Status existed even
prior to gaining disciplinary knowledge and skills or
assuming professional roles.
Some of them [medical students] felt like I got into
medical school and you're just a nurse. I felt that
some of them felt like they were better (Participant
2, nursing student). The power and status of
medicine were legitimized by the students because
of the role of the physician as the decision maker.
As one participant suggested, sometimes these
roles define our positions (Participant 3, medical
student). The sole responsibility of the doctor for
final decision making, also creates a power
differential through everything (Participant 7,
medical student).
The power that medicine and, by association, medical
students possesses, implies that those who enter medicine are superior and are almost more than human,
perhaps leading one participant to the need to affirm that
medical students are indeed human.
Nice to see that medical students are human beings,
capable of fault. (Participant 4, nursing student).
This mystique of omnipotence was both recognized and
perhaps dissipated through the interprofessional collaborative education experience for the nursing students. The
interprofessional experience reached around the relative
positioning of knowledge and power and revealed the
human fallibility of the medical students.
The potential of fallibility, for some nursing students,
significantly reduced the impact of power interactions
and perhaps generated a sense that future dialog might be
obtainable. For Participant 4, a nursing student, knowing
that medical students and physicians were fallible and
were not always right reduced a gap in which there was
power and intimidation, a change that could go a long
way toward helping doctors and nurses interact in the
professional setting (Participant 4).

The Power and Silence of Intimidation

Intimidation is the creation of the perception of fear (Dull
& Fox, 2010). It was a compelling, substantive element in
the experience of IPE and collaboration for nearly all
medical and nursing students in the study. For medical
students, it was the experience of being intimidating.
Even though they were not always cognizant of why or

how this occurred, they noticed that the nursing students

were uncomfortable and withdrawn in their interactions.
Hopefully, they are not intimidated by us, but they
[nursing students] were very quiet a lot of the time.
(Participant 16, medical student).
While it was unclear as to when perceptions or
awareness of power in their relationships had emerged,
for some, there was awareness that history and power had
shaped intimidation between nurses and physicians,
which had resulted in negative perceptions of
physiciannurse relationships.
There is a little bit of fear or stigma in the doctor/
nurse interprofessional relationship. (Participant
12, medical student).
There was also awareness that the interactions of the
nurses and physicians encountered by the students in the
practice or clinical areas were marked by a lack of comfort
or respect. This awareness sometimes influenced behavior as some of the medical students drew back from
interactions with the nursing students to be seen as less
intimidating.
A bit more of the old school attitudes and with some of
the older physicians, that's something that is pervasive.
Even today, there are some medical students who are
very rude to nurses. (Participant 10, medical student)
The medical students experienced the nursing students
as quiet, even silent. They were perplexed by the lack of
questions by the nursing students and their limited
participation in answering questions, which the medical
students attributed possibly to intimidation.
I think they [nursing students] were feeling kind
of uncomfortable or intimidated. (Participant 7,
medical student).
The absence of questions and answers from the nursing
students was interpreted as a lack of curiosity and
involvement in learning. This resulted in negative judgments
about the nursing students that potentially widened an
already existing gap between the two professions.
I know that I have gotten the impression that they
[the nurses] don't seem very interested in the
material and they don't seem very engaged with the
questions. They don't ask questions and they are on
their phones. I would say that medical students are
asking questions and super engaged and all over it.
(Participant 15, medical student).
The inquisitive nature of the medical students
suggested an importance related to questioning, perhaps
arising out of eagerness to know or a disciplinary
perspective. Within the context of medical practice,
doctors ask questions in order to achieve a diagnosis and
make decisions about treatment; learning, diagnosis, and

ARTICLE IN PRESS

treatment decisions are inextricably linked. There is,

however, an implicit control in questioning. Questions
can largely achieve the aims of the inquirer rather than of
the listener or the person being questioned (van Manen,
1997) and, thus, themselves imply dominance and power
in interactions, perhaps contributing to the intimidation
perceived by the nursing students.
For the nursing students, being intimidated was a
familiar experience during the IPE opportunities. For
some, it was the learning situation itself, where it was a
little intimidating when the speakers were asking
questions (Participant 5, nursing student), especially
perhaps when questions called for answers that were
unfamiliar to nursing students. There was fear in being
wrong, especially in front of the medical students.
For others, there was residue from previous interactions with physicians in which they thought they had
been ignored or treated as unimportant in the clinical
areas. This led to fear of further interactions with doctors
and by extension, with those who aspired to be doctors.
From first year until now, I hardly had any
interaction with any of the doctors. They kind of
ignore us when we are on the floor. (Participant 4,
nursing student).
For clinical, you don't get to talk in-depth with
doctors. They're busy and you're nervous, so it
doesn't always play out very well. (Participant 11,
nursing student)
For others, intimidation arose out of feeling of lesser
value than medical students or doctors, which was related
to perception of unequal power. Feeling undervalued
created a sense of uncomfortableness, fear and, occasionally, responses that were aggressive or defensive.
You're defensive and why? Cause you have a
perception that their profession has more power
than you do. (Participant 1, nursing student).
For some, the interprofessional learning experience
meant being silenced rather than being silent. Unfamiliarity with questioning styles and feelings of being less
powerful served to generate quietness in the nursing
students. Perhaps, too, listening was a familiar role to
nursing students, just as asking questions may have been
for medical students; listening is emphasized as a way to
hear the needs of patients and, thus, is linked to learning
in nursing. Because of their silence, the nursing
students found it difficult to share about themselves
and their roles.
They didn't give us a chance to explain our roles.
(Participant 4, nursing student).
Awareness of being intimidated and uncomfortable
created a dissonance in the nursing students, which was
recognized as a learning need. The nursing students
acknowledged that they needed to work on relationships

ENGEL ET AL

with medical students in which they were treated as a

person with significance and importance because we all
like to feel valued (Participant 2, nursing student). It
meant learning not so much about roles but about
learning about how to be in interprofessional relationships where they could be people and not simply
manifestations of expertise, education, or power.
I think I need that skill to know, don't be
intimidated by these people. They might have more
power than me someday, but like I need to know,
they're still people....it's funny, like when you are
open with them and you kind of understand them
more, you really are on equal grounds. (Participant
2, nursing student).

Discussion
The purpose of this supplementary analysis was to
explore the phenomenon of power, which was identified
as a thread throughout the primary study. Few studies
have explored the relationships between nursing and
medical students or have explored perceptions of power
and how these become incorporated into professional
identities. This study is unique in that it specifically
explores the experience of nursing and medical students
in IPE and their perceptions of each other. In particular,
our supplementary analysis of the primary study suggests
that the interactions of the students may serve to
maintain social constructions of power along the lines
of knowledge (Foucault, 1977) that have been historically established (Coburn, 2006; Hart, 2015; Price et al.,
2014) and accepted as potential or actual legitimate
authority (Weber, 1978). Our findings suggest that
power and power differentials are significant factors in
student interactions in interprofessional learning and have
the potential to adversely affect interactions. Those students
who perceive they have less power may in fact disengage
from the IPE experience, as evidenced by the silence and
limited participation of the nursing students in situations
and discussions. If continued, these behaviors may
negatively affect the open communication that is necessary
to accomplish the goals of interprofessional collaboration.
Power behaviors have long been identified among
nursing and medical practitioners and are thought to
arise from sociohistorical roots in which physicians are
the gatekeepers to health care and nurses are submissive
handmaidens (Keddy et al., 1986; Price et al., 2014).
What remains unclear from this study is when behaviors
and perceptions related to power are shaped and if, for
example, as Price et al. (2014) suggest, may actually be in
play prior to entering prelicensure nursing and medical
programs. Further investigation would be helpful in
understanding where and how perceptions of power
develop and how these influence the emerging professional identities of students in prelicensure professional
education programs.
There is need to understand how power is manifested
in IPE experiences and its potential long-term consequences for interprofessional practice. Interestingly, the

INTERPROFESSIONAL EDUCATION

ARTICLE IN PRESS

influences of power seem to be ameliorated once students

get to know one another on a personal level, which tends
to dissipate the mystique of knowledge and its power.
This suggests that interprofessional collaboration needs
to recognize the importance of social interaction rather
than simply focusing on expertise or understanding of
roles. Pullon (2008) discusses the importance of
socialization, including small talk and sharing of
humor, among physicians and nurses in the development
of interprofessional working relationships. This focus on
social interaction has implications for further planning in
IPE initiatives.

professionals? Such simple explorations may provide

opportunities to understand how nursing and other
professions, such as medicine, perceive and structure
power within everyday relationships. This type of
exploration would highlight the concept of power,
which is essentially a relational construct, and bring it
out into open dialog, where it could be better understood.

Implications and
Recommendations for Nursing Education

Conclusion

Although previous work in interprofessional collaboration and education stresses the importance of understanding each other's professional roles as an important
foundation in trust and overcoming hierarchy in
patient-centered care (Orchard et al., 2005), the findings
of this study suggest that, for nurses and particularly
nursing students, trust may first arise out of interpersonal
relationships rather than understanding of roles. An
emphasis on roles, which are understood perhaps even
prior to entering nursing, may actually serve to widen the
distance between nursing and medical students and
preserve hierarchy, as is evidenced in the perceptions of
medical students as being smarter and having important
knowledge that is congruent with their overall role of
decision maker in patient care. In order to reduce this
distance for nursing students, the findings of the study
suggest that familiarity with the medical students is
important. Strategies to increase familiarity might include
frequent opportunities to learn together, especially in
small groups, where there are increased openings to share
ideas and gain knowledge of one another. While learning
together is important, it may only result in parallel
acquisition of content and skills, and so, it is also
important to provide intentional activities that engage the
students at an interpersonal level in addition to academic
content and skills.
In addition to content acquisition and increased
understanding of roles, the findings of this study suggest
that there may be need to deliberately explore, either with
interprofessional learning groups or in nursing specific
learning groups, how power is constructed and maintained between professions such as medicine and
nursing. In nursing, for example, first names are
commonly used by nurses in clinical settings in their
interactions with patients and other team members, for
safety and other reasons, whereas patients and team
members may more commonly address physicians
formally by their title and last name (DeKeyser, Wruble,
& Margalith, 2003; Pringle, 2006). Because forms of
address confer and confirm social status (DeKeyser et al.,
2003), does the use of formal address with physicians
imply a higher status (DeKeyser et al., 2003), and does
the use of informal address with nurses serve to establish
status and maintain asymmetrical relationships among

Limitations
Students from one school of nursing and one medical
school were interviewed for this study. Therefore, their
experiences may not be reflective of all students.

Power is a prevailing component in relationships among

medical and nursing students in IPE within this study.
Further insight is needed to uncover and dispel
seemingly innate and implicit power perceptions in
prelicensure interprofessional learning before IPE can
fully realize its potential.

Declaration of Interest
The authors report no conflicts of interest.

References
Adams, K., Hean, S., Sturgis, P., & Macleod Clark, J. (2006).
Investigating the factors influencing the professional identity of
first-year health and social care students. Learning in Health and
Social Care, 5, 5568.
Baker, L., Egan-Lee, E., Martimianakis, M., & Reeves, S.
(2011). Relationships of power: Implications for interprofessional education. Journal of Interprofessional Care, 25, 98104,
http://dx.doi.org/10.3109/13561820.2010.505350.
Carpenter, J. (1995). Doctors and nurses: Stereotypes and
stereotype change in interprofessional education. Journal of
Interprofessional Care, 9, 151161, http://dx.doi.org/10.3109/
13561829509047849.
Clegg, S., Courpasson, D., & Phillips, N. (2011). Power and
organizations. Los Angeles, CA: Sage.
Coburn, D. (2006). Medical dominance then and now:
Critical reflections. Health Sociology Review, 15, 432443.
Corser, W. (1998). A conceptual model of collaborative
nurse-physician interactions: The management of traditional
influences and personal tendencies. Scholarly Inquiry for
Nursing Practice, 12, 325334 (336-341).
D'Amour, D., Ferrada-Videla, M., Rodriguez, L., & Beaulieu, M.
(2005). The conceptual basis for interprofessional collaboration: Core
concepts and theoretical frameworks. Journal of Interprofessional Care,
19, 116131, http://dx.doi.org/10.1080/13561820500083=22529.
DeKeyser, F., Wruble, A., & Margalith, I. (2003). Patients voice
issues of dress and address. Holistic Nursing Practice, 17, 290294,
http://dx.doi.org/10.1097/00004650-200311000-00003.
Dull, D., & Fox, L. (2010). Perception of intimidation in a
perioperative setting. American Journal of Medical Quality, 25,
8794, http://dx.doi.org/10.101177/1062860609352107.
Engel, J., & Prentice, D. (2013). The ethics of interprofessional
collaboration. Nursing Ethics, 20, 426435, http://dx.doi.org/
10.1177/0969733012468466.
Foucault, M. (1977). In A. Sheridan (Ed.). Discipline and
punish: the birth of the prison. London, UK: Allen & Lane.
Foucault, M. (1980). In C. Gordon (Ed.). Power/knowledge.
New York, NY: Pantheon.

ARTICLE IN PRESS

Hall, P. (2005). Interprofessional teamwork: Professional

cultures as barriers. Journal of Interprofessional Care, 19,
188196, http://dx.doi.org/10.1080/13561820500081745.
Hart, C. (2015). The elephant in the room: Nursing and
nursing power on an interprofessional team. Journal of
Continuing Education in Nursing, 46, 349355, http://
dx.doi.org/10.3928/00220124-20150721-01.
Heaton, J. (2004). Reworking qualitative data. Thousand Oaks,
CA: Sage.
Heidegger, M. (1992). Being and time. (J. Stambaugh, Trans).
Albany, NY: State University of New York Press.
Hofestede, G. (1980). Culture's consequences: International
differences in work-related values. Beverly Hills, CA: Sage.
Keddy, B., Gillis, M., Jacobs, B., Burton, H., & Rodgers, M.
(1986). The doctor-nurse relationship: An historical perspective. Journal of Advanced Nursing, 11, 745753.
Khalili, H., Orchard, C., Spence Laschinger, H., & Farah, R.
(2013). An interprofessional socialization framework for
developing an interprofessional identity among health professions students. Journal of Interprofessional Care, 27, 448453,
http://dx.doi.org/10.3109/13561820.2013.804042.
Marcinowicz, L., Foley, M., Zarzycka, D., Chlabicz, S.,
Windak, A., & Buczkowski, K. (2009). Polish medical students'
perceptions of the nursing profession: A cross-sectional study.
Scandinavian Journal of Caring Sciences, 23, 438445, http://
dx.doi.org/10.1111/j.1471.6712.2008.00638.x.
Orchard, C., Curran, V., & Kabene, S. (2005). Creating a
culture for collaborative professional practice. Medical Education Online, 10, 113.
Orchard, C., King, G., Khalili, H., & Bezzini, M. (2012).
Assessment of the interprofessional team collaboration scale
(AIPCS): Development and testing of the instrument. Journal of
Continuing Education in the Health Professions, 32, 5869.
Paradis, E., & Reeves, S. (2013). Key trends in interprofessional research: A macrosociological analysis from 1970-2010.
Journal of Interprofessional Care, 27, 113122, http://dx.doi.org/
10.3109/13561820.2012/7199313.

ENGEL ET AL

Prentice, D., Engel, J., Taplay, K., & Stobbe, K. (2014).

Interprofessional collaboration: The experience of nursing and
medical students' interprofessional education. Global Qualitative Nursing Research, 19, http://dx.doi.org/10.1177/
2333339361450566.
Price, S., Doucet, S., & Hall, L. (2014). The historical
positioning of nursing and medicine: Implications for career
choice, early socialization and interprofessional collaboration.
Journal of Interprofessional Care, 28, 103109, http://dx.doi.org/
10.3109/13561820.2013.867839.
Pringle, D. (2006). Hello. Im Sue, Im your nurse. Nursing
Leadership, 19, 12, http://dx.doi.org/10.12927/cjnl.2006.18165.
Pullon, S. (2008). Competence, respect and trust: key features
of successful interprofessional nurse-doctor relationships. Journal
of Interprofessional Care, 22, 133147.
QSR International Pty Ltd. (2012). NVivo version 9. 2012. Retrieved
from http://www.qsrinternational.com/products_nvivo.aspx.
Rieck, A. (2014). Exploring the nature of power distance on general
practitioners and community pharmacist relations in a chronic disease
management context. Journal of Interprofessional Care, 28, 440446,
http://dx.doi.org/10.3109/13561820.2014.906390.
Rudland, J., & Mires, G. (2005). Characteristics of doctors
and nurses as perceived by students entering medical school:
Implications for shared teaching. Medical Education, 39,
448455.
Thistlethwaite, J. (2012). Interprofessional education: A
review of the context, learning and research agenda. Medical
Education, 46, 5870.
van Manen, M. (1997). Researching lived experience: human
science for an action sensitive pedagogy. London, ON: Althouse
Press.
Veerapen, K., & Purkis, M. (2014). Implications of early
workplace experiences on continuing interprofessional education for physicians and nurses. Journal of Interprofessional Care,
28, 218225.
Weber, M. (1978). Economy and society: an outline of
interpretive sociology. Berkley, CA: University of California Press.