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How do nursing students regard their future career? Career preferences in the post-modern society
Nurse Education Today (2004) 24, 493–500
Nurse Education Today intl.elsevierhealth.com/journals/nedt
How do nursing students regard their future career? Career preferences in the post-modern society May-Karin Rognstada,*, Olaf Aaslandb,c, Vigdis Granuma a b c
Faculty of Nursing, Oslo University College, P.O. Box 4, St. Olavs Plass, N-0130 Oslo, Norway The Research Institute, Norwegian Medical Association, P.O. Box 1152, Sentrum, N-0107 Oslo, Norway Department of Health Management and Health Economics, University of Oslo, Norway
Accepted 25 July 2004
KEYWORDS
Summary This article presents findings from a study of 301 Norwegian nursing students’ opinions of their future career. The initial survey took place 7 months after the commencement of nursing training in 1998/99 with a follow-up after 2 1/2 years. Data was collated using a questionnaire with closed questions and supplemented by semi-structured in-depth, audio taped interviews concerning the students’ professional socialisation. The findings from the initial survey indicate that motives like human contact, helping others and job security (i.e. low risk of being laid off) were important. Plans for further education after finishing the bachelor programme in nursing were abundant. Analysis of the second data-set will show whether there is a change in the students’ plans for their future education and career. For nearly 80% of the students it was very important that the bachelor degree could serve as a basis for further education. Multiple regression analysis showed that nursing students who emphasise this importance are less interested in giving care and help to others, and this attitude is confirmed in the interviews. Career preferences were often midwifery, public health or practice in high tech areas like anaesthetics, and not care for chronically ill or elderly patients; areas where there is a shortage of nurses. c 2004 Elsevier Ltd. All rights reserved.
Nursing student; Career choice; Nursing practice; Norway
* Corresponding author. Tel.: +47 22 45 37 42; fax: +47 22 45 37 45. E-mail address: [email protected] (M.-K. Rognstad).
0260-6917/$ - see front matter c 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.nedt.2004.07.015
494
M.-K. Rognstad et al.
Introduction The public health service in Norway provides general and specialist health care in the community and specialist service in hospitals. An effective public health service is dependent on different types of nurse specialists. The demand for nurses does not always correspond to the number of nurses seeking employment in different specialised areas. There is a shortage of nurses in the care of chronically ill and elderly patients, and the number of older patients will increase during the next two decades. In Norway the process of converting the nursing vocation into a profession started in the 1960s. The development of a science of nursing was the overall goal that was regarded a necessity for nursing to be accepted as a profession (Melby, 1990). Therefore, the nursing undergraduate programme has changed considerably over the last decades, mainly in order to strengthen its theoretical basis. Practical clinical work has been reduced to make room for more academic subjects. Today’s bachelor programme is a result of this change (KUF, 2000). The purpose is to educate nurse-generalists who can later specialise. Between 1998 and 2001 about 3400 nursing students finished the three-year undergraduate programme in Norway each year (Report, Ministry of Health and Social Affairs 2002: 41) the intention being to maintain this level in the coming years. For nurse-generalists there are several different ways of making a career in Norway. The bachelor degree can be used in other vocations, like airline stewardess or a sales consultant in medical drugs or equipment. But there are also different careers
in nursing, as illustrated in Table 1 (Wang and Heimly, 1998; Havn, 1996; Hoel, 1995). Nurses who are not motivated for further college education are encouraged to make a career as a specialised nurse on the wards by taking short courses given by the local hospitals (Kvamme and Bjerke, 2003). As of October 2002, 431 experienced nurses, aged 40–50, have attended courses and received a license as a specially trained nurse.
Career choice The young nursing students in the post-modern society have different motives for choosing nursing education and the nursing profession. Motives like ‘‘help others’’, ‘‘do something useful’’ and ‘‘a safe job’’ are the most important (Rognstad, 2002; Williams et al., 1997; Veit, 1996; Maurer, 1998). Giddens (1991) and Ziehe (1989) describe how the changing value structure in society has led to a loss of uniform value systems. This clearly has a bearing on how students make their choices in life. According to Ziehe a ‘‘cultural emancipation’’ has taken place in recent years, resulting in more narcissistic tendencies in young people, characterised by a predominance of self-directed motives and values. According to Jensen (2003, p. 56), ‘‘the values the students reveal are typically related to personal development and the quest for work that they find meaningful and engaging’’. The increased possibilities of individualisation and the desire for personal development are typical for young people. Activities that imply joy and pleasure and ‘‘the good feelings’’ are experience as meaningful (La ¨hteenmaa, 1999). Disease, suffering and death,
Table 1 Specialisation
Education
Duration of study
Number of students in 1998–2000
Specialised nurse on ward Midwifery Public health visitor Intensive/critical care Operating theatre Nurse anaesthetist Oncology-nursing Paediatric nursing Psychiatric nursing Geriatric nursing Lecturer Head nurse on ward Associate professor
Local hospital courses University college University college University college University college University college University college University college University college University college Master program Master program PhD
months 1 year 1 year 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years 3 years
431 (1998–2002)
496 352 273 120 118 814 192
Sources: Wang and Heimly (1998); Havn (1996); Hoel (1995); Ministry of Health and Social Affairs (2002).
How do nursing students regard their future career? on the other hand, are kept out of sight (Knudsen, 1998). In this context, identity building takes place for young students, who may decide to change their life styles and even their social identity (Ziehe, 1989). Many students who enter a bachelor programme in nursing want to extend their education (Rognstad, 2002). There are many options for further education and specialisation. Some students are unsure of what to choose, only that they do not want to remain on the wards for more than one or two years. Other students are more determined about their future careers. Seven months after starting the bachelor programme, 92% of the students wanted to take further education. Of these, 12% wanted to continue on university level, and 82% of wanted to specialise in nursing, particularly midwifery or public health (Rognstad, 2001; Rognstad, 2002). Thus, the bachelor programme takes the students into a personal and professional process of socialisation, and opens up possibilities for further education to fulfil their desires and interests. With regard to nursing specialities, our findings (Rognstad, 2002) are supported by Happel (1999, p. 499) who identifies ‘‘popularity of specific areas of nursing in practice’’. ‘‘Midwifery and working with children account for almost half of first career preferences’’ and ‘‘areas of nursing practice involving significant levels of technology’’ are preferred. Happel continues: ‘‘Special areas such as working with elderly people, psychiatric nursing and community mental health nursing and developmental disability nursing were clearly the four least popular preferences’’. Enoksen and Støren (1990) show that Norwegian nurses choose further education. Ten years after finishing the undergraduate nursing programme 80% of 447 nurses (RN) completed a questionnaire. 81% of the nurses had completed a lower degree university course, and 2% a higher degree course in economy, administration or other health related subjects. There are few Norwegian nurses who prefer to specialise in geriatric nursing or to work with chronically ill and elderly patients (Hoel, 1995). This tendency is also found in other international studies (Zukerberg, 1991; Philipase et al., 1991; Stickney, 1985). Pursey and Luker (1995, p. 547) identified a lack of desire in nurses to work with older people. The authors conclude: ‘‘high dependency levels of older people and the structure of nursing work with older people in hospitals means that fewer nurses make this area a positive career choice’’. In Australia, Happel and Brooker (2001) found that a significant number of nursing students
495 consider caring for older adults to be boring, depressing, frightening, unsatisfying and limiting of their practice skills. The authors discuss the implications of these findings for the future care of elderly individuals, and the responsibility of the nursing profession as a whole to address this negative trend.
Part-time work The opportunity to work part-time does not seem to be of particular interest to nursing students (Rognstad, 2002). A Norwegian study on the moral motivation of nursing- and social work students founnd a low interest in the value of leisure and part-time work (Jensen and Amodt, 2002). However, in Norway part-time work is becoming a strategy for many nurses to organise their lives, particularly when they have small children (Abrahamsen, 1997). Hoel (1995) argues that young women choose more traditional vocations like nursing because it is more acceptable to withdraw from these careers for a time, with no fear of negative sanctions or future career restraints. A study from 2002 found that young and newly educated nurses want to work full time whereas nurses aged between thirty and forty with young children prefer part-time work (Olsen, 2002). There are four main reasons why nurses prefer part-time work, the difficulty of combining full time work with the care of a family being the most important. Other reasons are lack of full time employment, health problems, and the combination of work with other jobs or further education. Since an education in nursing may develop into different nursing and non-nursing careers, it should be of interest to gain more insight into the career plans of nurse students towards the end of the bachelor programme. If many of the students want to pursue other careers than nursing, it becomes a problem of recruitment, and thereby a political problem. It may be that the government should put more effort into the recruitment of nurses who are interested in giving care to patients with complex health problems, and to motivate them towards the care of the chronically ill and elderly patients. This study is an attempt to uncover the motivation career plans for nurse students. The following questions addressed: 1. What does it mean to nursing students to become nurses?
496 2. What plans do nursing students make for their future career?
Method Sample and design This study follows up an earlier survey about motivation and beliefs among first year nurse students (Rognstad, 2002). The respondents were recruited from three classes of students who started their nursing education in the autumn of 1998 at three different colleges in Oslo. From 1999 the three institutions were combined into one faculty, the Faculty of Nursing, University College of Oslo. The survey was done 6 months after the students commenced their studies. 397 students from all over Norway, an entire class, were selected and received questionnaires, which they completed and handed in immediately after a lecture. The response rate was 80% (N = 315). The present study took place in 2001 after the respondents had completed more than two and a half years of the three-year educational programme. Data was collected using a questionnaire with pre-coded answers. A total of 442 questionnaires were administrated, response rate was 68% (N = 301). In addition, 18 students were interviewed in depth about their professional identity building and career preferences. These students were selected on the basis of data from the 1999 survey, making sure to get both students who wanted to extend their career beyond nursing and students who wanted to stay with the nursing profession.
Survey The questionnaire included 54 closed questions. It was completed during a lecture and turned in immediately after a lecture. One part of the questionnaire was connected to questions regarding values, priorities and personal choices and included the following question. How do you want to make use of your bachelor degree? Response options were: (a) to use the bachelor degree in dierent vocation (b) the bachelor degree is a basis for further education and were evaluated on a five-point Likert scale from 1 (not important at all) to 5 (very important).
M.-K. Rognstad et al. The responses were dichotomised into not important (1–3) and important (4 and 5). Another question was as follows. How important will different conditions be when appraising a job? The following 12 statements were evaluated on a five point Likert scale from 1 (very important) to 5 (not important at all): (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (l)
Job security High salary Good possibilities to be promoted An interesting job A job where you can be independent A job where you can help others A job where you can do something useful A job with flexible working-time A job with plenty of spare time A job with human contact Possibilities for part-time working A job where you can create and form
These statements have been used in a Norwegian survey on ’’Work orientations’’ (Lund and Kalgraff Skja ˚k, 1997; Berg, 1998; Ottosen, 2001), and were again part of an international co-operation project (International Social Survey Project, ISSP). Frequency distribution, calculations of means and standard deviations, factor analysis and multiple linear regressions were used.
Results 301 questionnaires were completed of which 179 participants also were in the previous study. 74% answered that it is important that the nurse education makes a basis for further education. 31% of the students answered that it is important to use the bachelor degree in a different vocation. The responses to the question: How important will different conditions be when appraising a job? are summarised in Table 2. The mean values (Table 2) are ranked according to importance. High salary, plenty of spare time, flexible work-time and independent job are important conditions when appraising a job. To investigate the underlying dimensionality of the 12 statements we did a principal component analysis (Bryman and Cramer, 1990; Polit, 1996) on these 12 items, and identified four components with eigenvalue >1, described in Table 3. The first factor can be described as ‘‘care’’ and the second factor as ‘‘flexibility’’. The third factor
How do nursing students regard their future career?
497
Table 2 Conditions
N
Mean
SD
High salary A job with plenty of spare time A job with flexible work-time A job where you can be independent Possibilities for part-time working Good possibilities to be promoted A job where you can create and form Job security A job where you can do something useful A job where you can help others A job with human contact An interesting job
291 290 287 287 289 276 294 290 292 289 293 287
2.27 2.18 2.14 2.01 1.98 1.96 1.95 1.92 1.92 1.70 1.53 1.31
0.73 0.75 0.82 0.73 0.85 0.79 0.76 0.94 0.70 0.63 0.56 0.48
is ‘‘ambition’’ and the fourth ‘‘job security’’ (Table 3). We did multiple regression analyses with the four standardised factor scores as response variables and gender (female, male), age (21–25, 26– 30, 31–51 years), important to use the bachelor degree in different vocations (no, yes), and important to use the bachelor degree as basis for further education (no, yes), as effect variables, with the following results:
Nursing students who want to use the bachelor degree in different vocation are more interested in care (t = 2.4, p = 0.015).
Factor 1: ‘‘Care’’ Nursing students who emphasise the importance of the bachelor degree for further education are less interested in care (t = 2.9, p = 0.003).
Factor 4: ‘‘Job security’’ Male nurse students are more interested in job security than female students (t = 3.1, p = 0.002).
Table 3
Factor 2:‘‘Flexibility’’ No significant effects. Factor 3: ‘‘Ambition’’ Older nursing students are less ambitious than younger students (t = 2.4, p = 0.017).
Factor analysis, appraising job-conditions (N = 244)
Variables A job were you can help others A job were you can do something useful A job with human contact
Factor 1
Factor 2
Factor 3
0.841 0.717 0.696
A job were you can create and form An interesting job A job with plenty of spare time A job with flexible working-time Possibilities for part-time working
0.840 0.701 0.700
Good possibilities to be promoted High salary A job where you can be independent
0.833 0.718 0.558
Job security Eigenvalues Percentage of explained variance
Factor 4
0.904 2.8 19.9
1.8 15.1
1.4 14.9
1.1 9.1
Notes: Extraction of factors by principal component analysis with Varimax rotation (N = 244). Level of job-conditions with items reported from 1 (very important) to 5 (not important at all). Only loadings >0.500 are reported given in the table.
498
Interviews The analyses indicate that younger students are more ambitious than older students, and that they want a career with high salary and possibilities to be promoted. The students who emphasise the importance of further education are less interested in care. We wanted to find out more about the motives and career preferences of the students who want to extend their careers beyond regular nursing, and conducted 18 semi structured interviews that were audiotaped and transcribed. With regard to the question about plans for further education, different categories were identified in the text from the interviews (Miles and Huberman, 1994). For most of the students further education means to enter a specialist programme for nurses, and for some to study at the university. Six of the 18 students wanted to work with healthy people, and mentioned midwifery and public health. Some did not have plans yet, but felt certain that they would take further education. None of the students who wanted further education planned to work in hospitals for more than two years. With regard to the question on what it means to become a nurse, all students emphasised the importance of having a vocation where human contact is essential, and most of them added the importance of job security. Six quotations have been selected from the interviews. They were the most comprehensive, informative and well-formulated ones, emphasising the students’ opinion (Miles and Huberman). Berit (23) states ‘‘to become nurse means a lot to me’’ and she continues that it means a lot to go through the educational programme. ‘‘I was not sure I would manage’’. Now she is sure that she will be a good nurse. She thinks she has some of the qualities necessary to give care. She says she is nice, polite and honest, and she believes she has ‘‘a friendly manner, which is something patients need’’. For her the nursing profession is an ‘‘exciting profession and people appreciate that you have chosen the nursing profession’’ and ‘‘that means a lot to me’’. The nursing profession is varied and ‘‘there are possibilities for choosing further education’’. Berit likes children and wants to be a public health nurse, hopefully connected to a primary school. For her it is important to maintain the school health service, which in Norway has gradually been reduced.
M.-K. Rognstad et al. John (26) answers the question on what it means to become a nurse in this way: ‘‘it doesn’t mean that much to become nurse’’. He is looking forward to completing his studies and getting out ‘‘into the big world’’. He is satisfied because he now has a profession, but ‘‘I am not that happy’’. He will work as a nurse for a couple of years, and then enter a two-year programme at the University College to specialise in psychiatric nursing. For Lisa (25) being a nurse means she has a profession, and she is satisfied. She wanted a vocation where she could have human contact. For her ‘‘the nursing profession is a basis, an introduction to further studies’’, and she is happy for these possibilities. She is probably going to start to study psychology in the autumn. During her studies ‘‘I can work part time as a nurse. May be I will work with The Red Cross for a time. I also want to go back to Australia’’. Elsa (25) says: ‘‘Actually, I didn’t want to become a nurse. I wanted to become a medical doctor’’. But ‘‘it means that I have a profession where I can have human contact. I can give of myself and help others’’. She is interested in research and wants become a nurse anaesthetist. ‘‘I like technical procedures and that kind of thing, I feel it is exciting and unpredictable. I am quite sure I want further education, I don’t want to be an ordinary nurse’’. The reason for this, she says, is that ‘‘ I don’t want to work on the ward, washing, feeding and helping patients out of their beds and that kind of work’’. Nina (22) says that she now has a platform, having finished a three-year programme at a university college. She wanted to choose a profession where she could help people and have human contact. ‘‘It is sociable, you give of yourself and get something in return. It is not necessary to work as an ordinary nurse’’, however, ‘‘I need to work as a nurse a couple of years and then see if I want to become a midwife or to enter The Red Cross and work in developing countries’’. Kari (26) says that she now has a profession where she can have human contact. ‘‘There are a lot of possibilities for choosing further education’’, she says, ‘‘I am not confined to one vocation’’. She emphasises ‘‘her self-development’’. This was important to her when she chose the nursing profession. Kari looks forward to entering a two-year programme at University College to specialise in midwifery. ‘‘That will be exciting and you can participate in a great experience and the responsibility is enormous. . . You are alone with the mother-tobe even though you can call the doctor’’.
How do nursing students regard their future career?
Discussion Most students prefer a job were they could have ambitions, human contact and help others. However, for over 70% of the students the bachelor degree in nursing also seems to represents a basis for further education. Young nursing students in the post-modern society have a lot of possible career choices, it is not necessary to work as an ordinary nurse. Many students want to specialise in midwifery, public health or anaesthesia with the potential of promotion and higher salary. The students also have values and wishes related to personal development like ‘‘You give of yourself and get something in return’’ and ‘‘self-development’’. The desire for individual development and to form oneself is significant in young people. Job preferences are often related to pleasure and good feelings like ‘‘babies are nice and cute’’ (La ¨hteenmaa, 1999; Jensen, 2003). Some students ‘‘don’t want to be an ordinary nurse’’, meaning that they don’t want to work on the ward, washing and feeding patients. The meaning of becoming a nurse seems first and foremost to be related to the possibilities of further specialisation/education. Are nursing students educating themselves away from the patient? Many students prefer to work with healthy people, as public health visitors or midwives. To be a midwife ‘‘will be exciting and you can participate in a great experience’’ one student said. In the post-modern society, using one-self as a reference seems to be more important for the identity building and personal development than external ideals or role-models (Ziehe, 1989). Our society cultivates values like personal success and a healthy and welltrained body. Suffering from diseases and death is related to sadness (Knudsen, 1998). This may explain why a large number of the nursing students at the start of the nursing programme and also at the end of their studies head for midwifery or public health (Rognstad, 2002; Happel and Brooker, 2001; Pursey and Luker, 1995). Preferences do not seem to include care for the chronically ill or elderly patients, where the need for nurses is critical. There is a reason to ask: What kind of professional help do nursing students in the post-modern society want to give, and to whom do they want to give this help? Educators in the bachelor programme should be aware of young students’ preferences and highlight the challenges and diversities of care given to the chronically ill patients (young or old). It is also a challenge to politicians and administrators to put effort into recruiting nurses to ordinary
499 ward activities – the care for sick and suffering patients.
References Abrahamsen, B., 1997. Kvinner i omsorgsyrker. Papport nr. 6. Institute for Social Research, Oslo. Berg, H., 1998. Arbeid og verdier. Oslo: ECON. Horisont nr. 1. Bryman, A., Cramer, D., 1990. Quantitative Data Analysis for Social Scientists. Routledge, London. Enoksen, J.A., Støren, L.A., 1990. Arbeid, omsorg eller videreutdanning. Papport nr. 2. NIFU, Norwegian institute for studies in research and higher education, Oslo. Giddens, A., 1991. Modernity and Self-identity. Polity Press, Cambridge. Happel, B., 1999. When I grow up I want to be. . .? Where undergraduate student nurses Want to work after graduation. Journal of Advanced Nursing (29), 499–506. Happel, B., Brooker, J., 2001. Who will look after my grandmother?. Journal of Gerontological Nursing (12), 12–17. Havn, V., 1996. Videreutdanning blant sykepleiere, ergoterapeuter og radiografer. SINTEFF, Tronheim. Hoel, M., 1995. Yrkestilpasning og yrkesutvikling. Institutt for Social Research, Oslo. Jensen, K., 2003. Shifts in moral motivation among students in social work. In: Irene Levin (Ed.), Social Work, Research and Development, Oslo University College-report, 2003, No. 3. Jensen, K., Amodt, P.O., 2002. Moral motivation and the battle for students: the case of studies in nursing and social work in Norway. Higher Education 44, 361–378. Knudsen, A., 1998. Forgængelighedens forvaltning i Ploug Hansen (Ed.), Omsorg, kropp og død. Nordisk Forlag, København. KUF (Ministry of Church, Education and Research), 2000. General dan regulation. Kvamme, E., Bjerke, P., 2003. Kliniske spesialister. De Facto, Oslo. Lund, M., Kalgraff Skja ˚k, K., 1997. Arbeidsforhold og arbeidserfaring. Rapport nr.114. Norsk samfunnsvitenskapelig datatjeneste (NSD). La ¨hteenmaa, J., 1999. The hedonistic altruism of young voluntary workers. Journal of Youth Research 7, 18–37. Maurer, M.C., 1998. An identification of factors influencing preprofessional socialisation of aspirants? to the nursing-profession. Doctoral dissertation, Loyoloa Univerity of Chicago. Melby, K., 1990. Kall og kamp. J.W. Cappelens Forlag A.S. Oslo. Miles, M.B., Huberman, A.M., 1994. Qualitative Data Analysis. Sage, London. Ministry of Health and Social Affairs, 2002. Report No. 41. Olsen, T., 2002. Arbeidskraftreserven blant deltidsansatte. Rapport nr. 3. Agderforskning, Kristiansand. Ottosen, G., 2001. Menns og kviners arbeidsorientering. Institutt for sosiologi og Statsvitenskap, NTNU, Trondheim. Philipase, V., Tate, J., Jacobs, S., 1991. Review of nursing literature: evolution of gerontological education in nursing. Nursing & Health Care (12), 524–530. Polit, D.F., 1996. Data Analysis & Statistics. Appleton & Lang. Prentice-Hall, London. Pursey, A., Luker, K., 1995. Attitudes and stereotypes: nurses’ work with older people. Journal of Advanced Nursing (22), 547–555. Rognstad, M.K., 2001. Verdier i endring i sykepleie. Va ˚rd i Norden (3), 14–16.
500 Rognstad, M.K., 2002. Recruitment to and motivation for nursing education and the nursing profession. Journal of Nursing Education (7), 321–325. Social and Health Department, 2002. Rett Person pa ˚Rett Plass. Rapport nr. 2. Stickney, C., 1985. Wanted innovated nurses for long-term care. Geriatric Nursing (6), 342–344. Veit, A.C., 1996. Motive der Berufswahl und Erwartungen an den Beruf bei Auszubildenden in der Krakenpflege. Pflege, band 9, Heft 1, 61–71.
M.-K. Rognstad et al. Wang, I.L., Heimly, A., 1998. Etter og videreutdanning for sykepleiere. Rapport nr. 9. Nordland Research Institute. Williams, et al., 1997. Why students choose nursing?. Journal of Nursing Education 36, 34–348. Ziehe, T., 1989. Ambivalenser og mangfold. Forlaget Politisk revy, København. Zukerberg, E., 1991. Editorial. What’s a sharp nurse like you doing in LTC?. Geriatric Nursing (12), 113– 214.
Nurse Education Today intl.elsevierhealth.com/journals/nedt
How do nursing students regard their future career? Career preferences in the post-modern society May-Karin Rognstada,*, Olaf Aaslandb,c, Vigdis Granuma a b c
Faculty of Nursing, Oslo University College, P.O. Box 4, St. Olavs Plass, N-0130 Oslo, Norway The Research Institute, Norwegian Medical Association, P.O. Box 1152, Sentrum, N-0107 Oslo, Norway Department of Health Management and Health Economics, University of Oslo, Norway
Accepted 25 July 2004
KEYWORDS
Summary This article presents findings from a study of 301 Norwegian nursing students’ opinions of their future career. The initial survey took place 7 months after the commencement of nursing training in 1998/99 with a follow-up after 2 1/2 years. Data was collated using a questionnaire with closed questions and supplemented by semi-structured in-depth, audio taped interviews concerning the students’ professional socialisation. The findings from the initial survey indicate that motives like human contact, helping others and job security (i.e. low risk of being laid off) were important. Plans for further education after finishing the bachelor programme in nursing were abundant. Analysis of the second data-set will show whether there is a change in the students’ plans for their future education and career. For nearly 80% of the students it was very important that the bachelor degree could serve as a basis for further education. Multiple regression analysis showed that nursing students who emphasise this importance are less interested in giving care and help to others, and this attitude is confirmed in the interviews. Career preferences were often midwifery, public health or practice in high tech areas like anaesthetics, and not care for chronically ill or elderly patients; areas where there is a shortage of nurses. c 2004 Elsevier Ltd. All rights reserved.
Nursing student; Career choice; Nursing practice; Norway
* Corresponding author. Tel.: +47 22 45 37 42; fax: +47 22 45 37 45. E-mail address: [email protected] (M.-K. Rognstad).
0260-6917/$ - see front matter c 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.nedt.2004.07.015
494
M.-K. Rognstad et al.
Introduction The public health service in Norway provides general and specialist health care in the community and specialist service in hospitals. An effective public health service is dependent on different types of nurse specialists. The demand for nurses does not always correspond to the number of nurses seeking employment in different specialised areas. There is a shortage of nurses in the care of chronically ill and elderly patients, and the number of older patients will increase during the next two decades. In Norway the process of converting the nursing vocation into a profession started in the 1960s. The development of a science of nursing was the overall goal that was regarded a necessity for nursing to be accepted as a profession (Melby, 1990). Therefore, the nursing undergraduate programme has changed considerably over the last decades, mainly in order to strengthen its theoretical basis. Practical clinical work has been reduced to make room for more academic subjects. Today’s bachelor programme is a result of this change (KUF, 2000). The purpose is to educate nurse-generalists who can later specialise. Between 1998 and 2001 about 3400 nursing students finished the three-year undergraduate programme in Norway each year (Report, Ministry of Health and Social Affairs 2002: 41) the intention being to maintain this level in the coming years. For nurse-generalists there are several different ways of making a career in Norway. The bachelor degree can be used in other vocations, like airline stewardess or a sales consultant in medical drugs or equipment. But there are also different careers
in nursing, as illustrated in Table 1 (Wang and Heimly, 1998; Havn, 1996; Hoel, 1995). Nurses who are not motivated for further college education are encouraged to make a career as a specialised nurse on the wards by taking short courses given by the local hospitals (Kvamme and Bjerke, 2003). As of October 2002, 431 experienced nurses, aged 40–50, have attended courses and received a license as a specially trained nurse.
Career choice The young nursing students in the post-modern society have different motives for choosing nursing education and the nursing profession. Motives like ‘‘help others’’, ‘‘do something useful’’ and ‘‘a safe job’’ are the most important (Rognstad, 2002; Williams et al., 1997; Veit, 1996; Maurer, 1998). Giddens (1991) and Ziehe (1989) describe how the changing value structure in society has led to a loss of uniform value systems. This clearly has a bearing on how students make their choices in life. According to Ziehe a ‘‘cultural emancipation’’ has taken place in recent years, resulting in more narcissistic tendencies in young people, characterised by a predominance of self-directed motives and values. According to Jensen (2003, p. 56), ‘‘the values the students reveal are typically related to personal development and the quest for work that they find meaningful and engaging’’. The increased possibilities of individualisation and the desire for personal development are typical for young people. Activities that imply joy and pleasure and ‘‘the good feelings’’ are experience as meaningful (La ¨hteenmaa, 1999). Disease, suffering and death,
Table 1 Specialisation
Education
Duration of study
Number of students in 1998–2000
Specialised nurse on ward Midwifery Public health visitor Intensive/critical care Operating theatre Nurse anaesthetist Oncology-nursing Paediatric nursing Psychiatric nursing Geriatric nursing Lecturer Head nurse on ward Associate professor
Local hospital courses University college University college University college University college University college University college University college University college University college Master program Master program PhD
months 1 year 1 year 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years 2 years 3 years
431 (1998–2002)
496 352 273 120 118 814 192
Sources: Wang and Heimly (1998); Havn (1996); Hoel (1995); Ministry of Health and Social Affairs (2002).
How do nursing students regard their future career? on the other hand, are kept out of sight (Knudsen, 1998). In this context, identity building takes place for young students, who may decide to change their life styles and even their social identity (Ziehe, 1989). Many students who enter a bachelor programme in nursing want to extend their education (Rognstad, 2002). There are many options for further education and specialisation. Some students are unsure of what to choose, only that they do not want to remain on the wards for more than one or two years. Other students are more determined about their future careers. Seven months after starting the bachelor programme, 92% of the students wanted to take further education. Of these, 12% wanted to continue on university level, and 82% of wanted to specialise in nursing, particularly midwifery or public health (Rognstad, 2001; Rognstad, 2002). Thus, the bachelor programme takes the students into a personal and professional process of socialisation, and opens up possibilities for further education to fulfil their desires and interests. With regard to nursing specialities, our findings (Rognstad, 2002) are supported by Happel (1999, p. 499) who identifies ‘‘popularity of specific areas of nursing in practice’’. ‘‘Midwifery and working with children account for almost half of first career preferences’’ and ‘‘areas of nursing practice involving significant levels of technology’’ are preferred. Happel continues: ‘‘Special areas such as working with elderly people, psychiatric nursing and community mental health nursing and developmental disability nursing were clearly the four least popular preferences’’. Enoksen and Støren (1990) show that Norwegian nurses choose further education. Ten years after finishing the undergraduate nursing programme 80% of 447 nurses (RN) completed a questionnaire. 81% of the nurses had completed a lower degree university course, and 2% a higher degree course in economy, administration or other health related subjects. There are few Norwegian nurses who prefer to specialise in geriatric nursing or to work with chronically ill and elderly patients (Hoel, 1995). This tendency is also found in other international studies (Zukerberg, 1991; Philipase et al., 1991; Stickney, 1985). Pursey and Luker (1995, p. 547) identified a lack of desire in nurses to work with older people. The authors conclude: ‘‘high dependency levels of older people and the structure of nursing work with older people in hospitals means that fewer nurses make this area a positive career choice’’. In Australia, Happel and Brooker (2001) found that a significant number of nursing students
495 consider caring for older adults to be boring, depressing, frightening, unsatisfying and limiting of their practice skills. The authors discuss the implications of these findings for the future care of elderly individuals, and the responsibility of the nursing profession as a whole to address this negative trend.
Part-time work The opportunity to work part-time does not seem to be of particular interest to nursing students (Rognstad, 2002). A Norwegian study on the moral motivation of nursing- and social work students founnd a low interest in the value of leisure and part-time work (Jensen and Amodt, 2002). However, in Norway part-time work is becoming a strategy for many nurses to organise their lives, particularly when they have small children (Abrahamsen, 1997). Hoel (1995) argues that young women choose more traditional vocations like nursing because it is more acceptable to withdraw from these careers for a time, with no fear of negative sanctions or future career restraints. A study from 2002 found that young and newly educated nurses want to work full time whereas nurses aged between thirty and forty with young children prefer part-time work (Olsen, 2002). There are four main reasons why nurses prefer part-time work, the difficulty of combining full time work with the care of a family being the most important. Other reasons are lack of full time employment, health problems, and the combination of work with other jobs or further education. Since an education in nursing may develop into different nursing and non-nursing careers, it should be of interest to gain more insight into the career plans of nurse students towards the end of the bachelor programme. If many of the students want to pursue other careers than nursing, it becomes a problem of recruitment, and thereby a political problem. It may be that the government should put more effort into the recruitment of nurses who are interested in giving care to patients with complex health problems, and to motivate them towards the care of the chronically ill and elderly patients. This study is an attempt to uncover the motivation career plans for nurse students. The following questions addressed: 1. What does it mean to nursing students to become nurses?
496 2. What plans do nursing students make for their future career?
Method Sample and design This study follows up an earlier survey about motivation and beliefs among first year nurse students (Rognstad, 2002). The respondents were recruited from three classes of students who started their nursing education in the autumn of 1998 at three different colleges in Oslo. From 1999 the three institutions were combined into one faculty, the Faculty of Nursing, University College of Oslo. The survey was done 6 months after the students commenced their studies. 397 students from all over Norway, an entire class, were selected and received questionnaires, which they completed and handed in immediately after a lecture. The response rate was 80% (N = 315). The present study took place in 2001 after the respondents had completed more than two and a half years of the three-year educational programme. Data was collected using a questionnaire with pre-coded answers. A total of 442 questionnaires were administrated, response rate was 68% (N = 301). In addition, 18 students were interviewed in depth about their professional identity building and career preferences. These students were selected on the basis of data from the 1999 survey, making sure to get both students who wanted to extend their career beyond nursing and students who wanted to stay with the nursing profession.
Survey The questionnaire included 54 closed questions. It was completed during a lecture and turned in immediately after a lecture. One part of the questionnaire was connected to questions regarding values, priorities and personal choices and included the following question. How do you want to make use of your bachelor degree? Response options were: (a) to use the bachelor degree in dierent vocation (b) the bachelor degree is a basis for further education and were evaluated on a five-point Likert scale from 1 (not important at all) to 5 (very important).
M.-K. Rognstad et al. The responses were dichotomised into not important (1–3) and important (4 and 5). Another question was as follows. How important will different conditions be when appraising a job? The following 12 statements were evaluated on a five point Likert scale from 1 (very important) to 5 (not important at all): (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (l)
Job security High salary Good possibilities to be promoted An interesting job A job where you can be independent A job where you can help others A job where you can do something useful A job with flexible working-time A job with plenty of spare time A job with human contact Possibilities for part-time working A job where you can create and form
These statements have been used in a Norwegian survey on ’’Work orientations’’ (Lund and Kalgraff Skja ˚k, 1997; Berg, 1998; Ottosen, 2001), and were again part of an international co-operation project (International Social Survey Project, ISSP). Frequency distribution, calculations of means and standard deviations, factor analysis and multiple linear regressions were used.
Results 301 questionnaires were completed of which 179 participants also were in the previous study. 74% answered that it is important that the nurse education makes a basis for further education. 31% of the students answered that it is important to use the bachelor degree in a different vocation. The responses to the question: How important will different conditions be when appraising a job? are summarised in Table 2. The mean values (Table 2) are ranked according to importance. High salary, plenty of spare time, flexible work-time and independent job are important conditions when appraising a job. To investigate the underlying dimensionality of the 12 statements we did a principal component analysis (Bryman and Cramer, 1990; Polit, 1996) on these 12 items, and identified four components with eigenvalue >1, described in Table 3. The first factor can be described as ‘‘care’’ and the second factor as ‘‘flexibility’’. The third factor
How do nursing students regard their future career?
497
Table 2 Conditions
N
Mean
SD
High salary A job with plenty of spare time A job with flexible work-time A job where you can be independent Possibilities for part-time working Good possibilities to be promoted A job where you can create and form Job security A job where you can do something useful A job where you can help others A job with human contact An interesting job
291 290 287 287 289 276 294 290 292 289 293 287
2.27 2.18 2.14 2.01 1.98 1.96 1.95 1.92 1.92 1.70 1.53 1.31
0.73 0.75 0.82 0.73 0.85 0.79 0.76 0.94 0.70 0.63 0.56 0.48
is ‘‘ambition’’ and the fourth ‘‘job security’’ (Table 3). We did multiple regression analyses with the four standardised factor scores as response variables and gender (female, male), age (21–25, 26– 30, 31–51 years), important to use the bachelor degree in different vocations (no, yes), and important to use the bachelor degree as basis for further education (no, yes), as effect variables, with the following results:
Nursing students who want to use the bachelor degree in different vocation are more interested in care (t = 2.4, p = 0.015).
Factor 1: ‘‘Care’’ Nursing students who emphasise the importance of the bachelor degree for further education are less interested in care (t = 2.9, p = 0.003).
Factor 4: ‘‘Job security’’ Male nurse students are more interested in job security than female students (t = 3.1, p = 0.002).
Table 3
Factor 2:‘‘Flexibility’’ No significant effects. Factor 3: ‘‘Ambition’’ Older nursing students are less ambitious than younger students (t = 2.4, p = 0.017).
Factor analysis, appraising job-conditions (N = 244)
Variables A job were you can help others A job were you can do something useful A job with human contact
Factor 1
Factor 2
Factor 3
0.841 0.717 0.696
A job were you can create and form An interesting job A job with plenty of spare time A job with flexible working-time Possibilities for part-time working
0.840 0.701 0.700
Good possibilities to be promoted High salary A job where you can be independent
0.833 0.718 0.558
Job security Eigenvalues Percentage of explained variance
Factor 4
0.904 2.8 19.9
1.8 15.1
1.4 14.9
1.1 9.1
Notes: Extraction of factors by principal component analysis with Varimax rotation (N = 244). Level of job-conditions with items reported from 1 (very important) to 5 (not important at all). Only loadings >0.500 are reported given in the table.
498
Interviews The analyses indicate that younger students are more ambitious than older students, and that they want a career with high salary and possibilities to be promoted. The students who emphasise the importance of further education are less interested in care. We wanted to find out more about the motives and career preferences of the students who want to extend their careers beyond regular nursing, and conducted 18 semi structured interviews that were audiotaped and transcribed. With regard to the question about plans for further education, different categories were identified in the text from the interviews (Miles and Huberman, 1994). For most of the students further education means to enter a specialist programme for nurses, and for some to study at the university. Six of the 18 students wanted to work with healthy people, and mentioned midwifery and public health. Some did not have plans yet, but felt certain that they would take further education. None of the students who wanted further education planned to work in hospitals for more than two years. With regard to the question on what it means to become a nurse, all students emphasised the importance of having a vocation where human contact is essential, and most of them added the importance of job security. Six quotations have been selected from the interviews. They were the most comprehensive, informative and well-formulated ones, emphasising the students’ opinion (Miles and Huberman). Berit (23) states ‘‘to become nurse means a lot to me’’ and she continues that it means a lot to go through the educational programme. ‘‘I was not sure I would manage’’. Now she is sure that she will be a good nurse. She thinks she has some of the qualities necessary to give care. She says she is nice, polite and honest, and she believes she has ‘‘a friendly manner, which is something patients need’’. For her the nursing profession is an ‘‘exciting profession and people appreciate that you have chosen the nursing profession’’ and ‘‘that means a lot to me’’. The nursing profession is varied and ‘‘there are possibilities for choosing further education’’. Berit likes children and wants to be a public health nurse, hopefully connected to a primary school. For her it is important to maintain the school health service, which in Norway has gradually been reduced.
M.-K. Rognstad et al. John (26) answers the question on what it means to become a nurse in this way: ‘‘it doesn’t mean that much to become nurse’’. He is looking forward to completing his studies and getting out ‘‘into the big world’’. He is satisfied because he now has a profession, but ‘‘I am not that happy’’. He will work as a nurse for a couple of years, and then enter a two-year programme at the University College to specialise in psychiatric nursing. For Lisa (25) being a nurse means she has a profession, and she is satisfied. She wanted a vocation where she could have human contact. For her ‘‘the nursing profession is a basis, an introduction to further studies’’, and she is happy for these possibilities. She is probably going to start to study psychology in the autumn. During her studies ‘‘I can work part time as a nurse. May be I will work with The Red Cross for a time. I also want to go back to Australia’’. Elsa (25) says: ‘‘Actually, I didn’t want to become a nurse. I wanted to become a medical doctor’’. But ‘‘it means that I have a profession where I can have human contact. I can give of myself and help others’’. She is interested in research and wants become a nurse anaesthetist. ‘‘I like technical procedures and that kind of thing, I feel it is exciting and unpredictable. I am quite sure I want further education, I don’t want to be an ordinary nurse’’. The reason for this, she says, is that ‘‘ I don’t want to work on the ward, washing, feeding and helping patients out of their beds and that kind of work’’. Nina (22) says that she now has a platform, having finished a three-year programme at a university college. She wanted to choose a profession where she could help people and have human contact. ‘‘It is sociable, you give of yourself and get something in return. It is not necessary to work as an ordinary nurse’’, however, ‘‘I need to work as a nurse a couple of years and then see if I want to become a midwife or to enter The Red Cross and work in developing countries’’. Kari (26) says that she now has a profession where she can have human contact. ‘‘There are a lot of possibilities for choosing further education’’, she says, ‘‘I am not confined to one vocation’’. She emphasises ‘‘her self-development’’. This was important to her when she chose the nursing profession. Kari looks forward to entering a two-year programme at University College to specialise in midwifery. ‘‘That will be exciting and you can participate in a great experience and the responsibility is enormous. . . You are alone with the mother-tobe even though you can call the doctor’’.
How do nursing students regard their future career?
Discussion Most students prefer a job were they could have ambitions, human contact and help others. However, for over 70% of the students the bachelor degree in nursing also seems to represents a basis for further education. Young nursing students in the post-modern society have a lot of possible career choices, it is not necessary to work as an ordinary nurse. Many students want to specialise in midwifery, public health or anaesthesia with the potential of promotion and higher salary. The students also have values and wishes related to personal development like ‘‘You give of yourself and get something in return’’ and ‘‘self-development’’. The desire for individual development and to form oneself is significant in young people. Job preferences are often related to pleasure and good feelings like ‘‘babies are nice and cute’’ (La ¨hteenmaa, 1999; Jensen, 2003). Some students ‘‘don’t want to be an ordinary nurse’’, meaning that they don’t want to work on the ward, washing and feeding patients. The meaning of becoming a nurse seems first and foremost to be related to the possibilities of further specialisation/education. Are nursing students educating themselves away from the patient? Many students prefer to work with healthy people, as public health visitors or midwives. To be a midwife ‘‘will be exciting and you can participate in a great experience’’ one student said. In the post-modern society, using one-self as a reference seems to be more important for the identity building and personal development than external ideals or role-models (Ziehe, 1989). Our society cultivates values like personal success and a healthy and welltrained body. Suffering from diseases and death is related to sadness (Knudsen, 1998). This may explain why a large number of the nursing students at the start of the nursing programme and also at the end of their studies head for midwifery or public health (Rognstad, 2002; Happel and Brooker, 2001; Pursey and Luker, 1995). Preferences do not seem to include care for the chronically ill or elderly patients, where the need for nurses is critical. There is a reason to ask: What kind of professional help do nursing students in the post-modern society want to give, and to whom do they want to give this help? Educators in the bachelor programme should be aware of young students’ preferences and highlight the challenges and diversities of care given to the chronically ill patients (young or old). It is also a challenge to politicians and administrators to put effort into recruiting nurses to ordinary
499 ward activities – the care for sick and suffering patients.
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