By: Mona M. Shattell, MS, RN, C; Nancy B. Moody, DSN, RN;
Robin Hawkins, BSN, RN; Joan L. Creasia, PhD, RN
Factors influencing the supply and demand of nurses are complex and involve issues such as the shifting health care delivery system, an aging nursing workforce, and the changing demographics of society. Projections for the supply and demand of the nursing workforce reveal an emerging nursing shortage (American Association of Colleges of Nursing, 2000a; Bednash, 2000; Buerhaus, 1998; Buerhaus, Staiger, & Auerbach, 2000; Mailey, Charles, Piper, Hunt-McCool, Wilborne-Davis, & Baigis, 2000; Mills & Blaesing, 2000). The American Association of Colleges of Nursing (AACN) and the National League for Nursing (NLN) report a decrease in applications to, and enrollment in, all nursing programs. According to the latest survey by the American Association of Colleges of Nursing (2000b), enrollments in baccalaureate degree nursing programs have decreased for the sixth straight year, with a 4.9% drop in 1999 and a 2.1% drop in 2000. Why are students not choosing nursing as a career? What can be done to increase enrollments in nursing programs?
Literature Review
Most of the research on nursing as a career choice examine the perceptions of high school students towards a career in nursing (Grossman, Arnold, Sullivan, Cameron, & Munro, 1989; Kohler & Edwards, 1990; Stevens & Walker, 1993; Tomey, Schwier, Marticke, & May, 1996), the perceptions of school age and high school students (Brown & Foskett, 1999), the perceptions of nursing and non-nursing college students toward a career in nursing (Kersten, Bakewell, & Meyer, 1991; Mendez & Louis, 1991; While & Blackman, 1998), and the role of gender in career selection (Boughn, 2001; Boughn & Lentini, 1999; Magnussen, 1998).
Perceived low status with manual labor (Hensley-Brown & Foskett, 1999), dislike of death and dying and hours worked (Stevens & Walker, 1993) were found to be reasons why students do not pursue nursing as a career. Students who chose to pursue nursing as a career most often cited a desire to help people, work with diverse populations, and a longing to do important work (Stevens & Walker, 1993). Boughn and Lentini (1999) found that nursing students perceived nursing work as powerful and that the driving force behind choosing nursing as a career was the desire to care for people. Practical aspects such as salary, benefits, working conditions, and job security were not expressed as motivational factors in choosing nursing as a profession (Boughn, 2001; Boughn & Lentini, 1999). Grossman et al. (1989) reported a lack of knowledge concerning the potential roles and advancement opportunities of nursing.
Previous research has found negative perceptions of nursing as a career from high school and college students. Fewer studies have examined students who chose nursing as a career. The purpose of this study was to gather information from current nursing students on factors that influenced their career choice, their perception of the positive and negative aspects of nursing, their perception of the ideal nurse, and their five-year career plan.
Method and Procedure
Student nurses were recruited during registration at an annual state nursing student association conference in the southeast. A convenience sample of 69 participants was achieved which represented virtually all of the registrants at the conference. Participants who agreed to take part in the study were given a survey tool, which consisted of demographic questions and open-ended questions about their decision to choose nursing as a career. They were also given a blank index card to register for a drawing to win $35 (the cost of registration for the convention). Survey tools were returned to the conference registration table and placed in a marked box. Data were analyzed using quantitative and qualitative methodology. Demographic data were analyzed using SPSS to obtain descriptive statistics of the sample. Open-ended questions were analyzed using content analysis and pattern coding techniques.
Results and Discussion
As reflected in Table 1, the majority of the sample were women (95.7%, n=66), Euro-American (85.5%, n=59), between 19-23 years of age (52%, n=36) and in baccalaureate degree programs (63.8%, n=44).
Table 1. Demographic Characteristics
N=69
|
Age |
|
|
19 – 23 |
52% |
|
24 – 36 |
39% |
|
37 – 47 |
9% |
|
Gender |
|
|
Female |
95.7% |
|
Male |
4.3% |
|
Ethnicity |
|
|
Euro-American |
85.5% |
|
African-American |
11.6% |
|
Asian-American |
2.9% |
|
Type of Nursing Program |
|
|
Associate Degree |
36.2% |
|
Baccalaureate Degree |
63.8% |
Factors that Influence Career Choice
In order for student recruitment to be aimed toward the appropriate age groups, it is important to know when students make career decisions. When nursing was first considered as a career and when nursing was decided upon as a career yield important information about career decisions. The majority of our sample first considered nursing as a career in high school (37.7%, n=26), followed by college or university (27.5%, n=19), and grade school (14.5%, 10). The majority decided on nursing as a career after entering college (44.9%, n=31), followed by high school (29%, n=20). These results indicate that recruitment programs should be targeting freshman college students who have not yet decided on a major. College students, who are already admitted to the college or university but have not chosen a career track, and high school students should be prime targets for nursing program recruiters.
For 47.8% (n=33) of the sample whose career choice was influenced by a person or event, the two main categories of responses were family members/significant others and nursing-in-action. Family members/significant others consisted of family members (nurses and non-nurses), friends, teachers, and God. Influential family members who were nurses included the following: grandmothers (n=3), mothers (n=2), other relatives and friends. Teachers cited were most often high school teachers who taught health occupations and health classes. God was listed by three participants as being influential in the decision to consider nursing as a career.
Observing nurses actively engaged in nursing also influenced participants’ career choices. Work experience influenced four participants to consider nursing as a career. Two participants worked as nurses aides, one participant was an LPN, and another worked in an unspecified role in a hospital. Other participants observed family members or significant others who were cared for by nurses. Most often, the grandmother or ‘self’ were listed as the ill family member. To summarize the nursing-in-action theme, in the words of one participant, “I saw what a difference a caring and compassionate nurse can make in someone’s life.” These experiences were mostly in the emergency room where nurses were described as “beautiful,” “great,” and “wonderful.” Participants wanted to give back to others, that which was given to them.
Factors influencing the participants’ decisions to become a nurse were categorized into five themes: focus on others, focus on self, people and experiences, God, and nursing as a default choice. Focus on others included helping people, caring for others, serving others, nurturing, and the ability to have an impact on others. Focus on self included statements about job security, a stable career, job opportunities, pay, flexibility, advancement opportunities, and an interest in health care. People and experiences that were influential in their decision to enter nursing as a career included nurses, high school health career teachers, family members, friends, and work experience in a health care setting. God was referred to as influential in the decision through a “calling” in that it was “what I was supposed to do.” Nursing as a default choice (second choice to what they really wanted to do such as careers in medicine, law, pharmacy, and physical therapy) was attributed to the students desire for marriage and family.
An overwhelming number of participants reported that helping people and making a difference in peoples lives were the most positive aspects of being a nurse. Most participants reported feeling satisfied and rewarded as evidenced by patient behaviors, such as “smiles,” “compliments,” “improved patient condition,” “feeling better,” and “improved quality of life.” Helping people in need was often accompanied by personal satisfaction of “knowing that someone felt better because of what I did.” Several participants reported personal contact with people and the intimate involvement in another’s life were the most positive aspects of nursing as a career. In addition, other participants described the high respect from society as the most positive aspect of being a nurse. Career opportunities were the most positive aspects of nursing as indicated by the following participant statements: “part of a growing profession,” “flexible schedule,” “many possibilities,” “so many choices,” and “a broad range of fields.” These findings are consistent with those reported by Stevens and Walker (1993) and Boughn and Lentini (1999).
Working conditions (71%), emotional strain (11.6%), and liability (5.6%) were themes for the least positive aspects of nursing as a career. Working conditions cited in descending rank order included staffing issues (not enough staff), workload, pay, long hours, working holidays, and paperwork. Participants believed that high nurse-patient ratios were the least positive aspect of nursing. They reported not being able to provide adequate nursing care due to time constraints, a lack of staff, and shortened length of hospital stay. The theme of emotional strain included feelings of helplessness and inadequacy with patients who were terminally ill or with those whose pain could not be relieved. Some participants reported dealing with death as the least positive aspect of nursing, stating that they feared becoming attached to patients and subsequently losing them. Other participants stated that the least positive aspect of becoming a nurse is the negative impact of the carryover of stress from work to home.
Perception of the Ideal Nurse
Caring was reported most frequently (75.4%, n=52) as an attribute of the ideal nurse. Other attributes reported were compassion (n=19), knowledge (n=16), interpersonal skills (n=13), skills (n=8), honesty (n=8), empathy (n=8), intelligence (n=7), and patient/family advocate (n=6). Five participants reported think quickly, hard working, competent, and sense of humor as attributes of the ideal nurse. Interestingly, three participants stated that accuracy and “always being right” were attributes of the ideal nurse. Only two participants listed the attributes “well-educated” and “leader”. “Problem-solving” was only mentioned once and the ability to critically think was notably absent. While nurse educators tout the importance of education, leadership, critical thinking and problem solving, the current students did not note these as attributes of the ideal nurse.
Five-Year Career Plan
Participants’ projections about what they will be doing in their career life as a nurse five years after graduation were categorized into nursing roles, continuing education, work setting, patient populations, and comfort/competency. Consistent with the literature, baccalaureate degree students were more likely to envision furthering their education than the associate degree students were. For example, 17 BSN students mentioned the advanced practice role, versus 3 AD students; 18 BSN students reported continuing education, versus 9 AD students. The work setting reported most often by both AD and BSN students was the hospital, followed by community/public health, doctors’ offices, and education in descending rank order. Patient populations reported by participants were pediatrics, obstetrics, neonatology, hospice, critical care, surgical, and medical. The absence of mental health and gerontology in both work setting and patient populations is notable. Comfort/competency was another category of responses to the career goal question. Participants hoped to feel comfortable in their roles and confident in their skills. The participants’ current insecurities about assuming the nurse role are apparent in their responses here.
Conclusions and Implications
The data suggest that nursing student career choice is often influenced by family members/significant others as well as by seeing nurses in practice. The majority of this sample first considered nursing as a career in high school and decided upon nursing as a career in college. Desire to help others was the chief reason nursing was chosen as a career followed by personal motivations such as those pertaining to job security and career opportunities. The most positive aspects of being a nurse were the opportunities to help people and to make a difference in another’s life. The least positive aspects were largely related to working conditions such as staffing issues, workload, work hours, and paperwork. Caring and compassion were the most cited attributes of the ideal nurse. Five years after graduation, many participants saw themselves working in a hospital setting with pediatric, obstetric, critical care, medical, or surgical patient populations. The five-year career plan of the BSN students included more advanced practice roles and continued education than did the AD students.
As a result of this pilot study, the survey tool was revised and is being used in a larger study of a statewide sample of nursing students. The findings of this study could be used to target strategies to recruit students into nursing. Role models have been shown to influence nursing as a career choice. School nurses and high school health teachers can serve as role models and liaisons to nurses working in the community. Nursing organizations could collaborate with programs such as the Big Brother/Big Sister program to facilitate relationships between youth and nurse role models. Nursing school faculty could be more involved in the community such as with the YMCA/YWCA, community health centers, and high schools. An education campaign on advanced practice nursing roles as well as in leadership, health policy, research, and administration could be initiated. The findings from this study of nursing students’ career choice could help us better understand the process of choosing nursing as a career thereby enabling us to design recruitment strategies to boost nursing program enrollment.
All authors are affiliated with the College of Nursing, University of Tennessee at Knoxville: Mona M. Shattell, MS, RN, C, Doctoral Student; Nancy B. Moody, DSN, RN, Associate Professor and Executive Director, Tennessee HealthCare Consortium for Nursing; Robin Hawkins, BSN, RN, Master’s Student; Joan L. Creasia, PhD, RN, Dean
This study was funded by the Tennessee HealthCare Consortium for Nursing. Appreciation is expressed to each of the students who participated in this study, to Ann Walker, MSN, RN, Tennessee Wesleyan College Fort Sanders Nursing Department and liaison to Tennessee Association of Student Nurses (TASN), and Tiffany Kibbler, past president of TASN.
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