Nurses Returning to School: Motivators, Inhibitors and Job Satisfaction

    Nurses Returning to School: Motivators, Inhibitors and Job Satisfaction Patrick Harris, Mary E. Burman PII: DOI: Reference:

S8755-7223(15)00127-1 doi: 10.1016/j.profnurs.2015.10.008 YJPNU 933

To appear in:

Journal of Professional Nursing

Please cite this article as: Harris, P. & Burman, M.E., Nurses Returning to School: Motivators, Inhibitors and Job Satisfaction, Journal of Professional Nursing (2015), doi: 10.1016/j.profnurs.2015.10.008

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Nurses Returning to School: Motivators, Inhibitors and Job Satisfaction

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Patrick Harris

Principal Economist

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Wyoming Department of Workforce Services

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Mary E. Burman

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Dean and Professor

University of Wyoming

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Fay W. Whitney School of Nursing

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ACCEPTED MANUSCRIPT Abstract Health care employers and national nursing organizations are placing increased emphasis

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on nurses earning a baccalaureate degree or higher. This study examines the impact of

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motivators (professional and personal motivation), inhibitors (time constraints and employer discouragement) and job satisfaction on intent to return to school.

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Approximately half of the employed nurses in Wyoming were surveyed using a mailed

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questionnaire in the summer of 2013. Perceived employer discouragement and time constraints continued to play a direct role on intent to return to school regardless of nurse

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motivation or job satisfaction. However, motivation and job satisfaction also contributed to a nurse’s intent to return to school. These results suggest that motivation and job

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satisfaction are significant regarding intent to return to school, but can be limited by both

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perceived discouragement of one’s employer and perceived time constraints. In order to

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meet the increasing demands of a better-educated nursing workforce, a shift in workplace

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dynamics may be warranted.

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ACCEPTED MANUSCRIPT Nurses Returning to School: Motivators, Inhibitors and Job Satisfaction The Institute of Medicine (2010), in their Future of Nursing report, recommend that

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80% of nurses have baccalaureate degree or higher by 2020 given studies documenting the

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impact of nursing education on patient outcomes (e.g., surgical complications and mortality rates). The Institute of Medicine also recommends that the number of nurses with doctoral

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degrees double by 2020 for advanced practice nursing and nursing education.

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Consequently, many nurses are returning to school for a baccalaureate degree or higher. Although an increasing amount of emphasize has been placed on nurses obtaining

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baccalaureate and higher degrees, our understanding of the impact of motivators and inhibitors is still relatively limited. Moreover, the impact of job satisfaction on return to

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school has received only scant attention.

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This study examines the impact of motivators (professional and personal

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motivation), inhibitors (time constraints and employer discouragement) and job satisfaction on intent to return to school. As the demand for RNs with baccalaureate

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education continues to increase, understanding factors that motivate or inhibit returning to school is critical to development of streamlined processes for academic progression, one of the key priorities of the IOM Future of Nursing report. Moreover, examining the impact of work-related factors, such as job satisfaction, will provide more understanding of the impact of complex interplay of the nurse and employer in decisions to return to school. Literature Review Registered Nurses (RNs) returning to school report a variety of motivators including personal and professional growth, desire for graduate education, improved self-esteem, timing, “user-friendly” programs, colleague/peer/family encouragement, employer

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ACCEPTED MANUSCRIPT incentives, lack of credibility without a BSN, and increased salary (Altmann, 2011; Broussard & White, 2014; Delaney & Piscopo, 2004; Duffy et al., 2014; Gillespie & Langston,

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2014; Landry, Orsolini-Hain, Renwanz-Boyle, Alameida, & Holpit, 2012; Megginson, 2008;

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Murphy, Cross, & McGuire 2006; Ritchie, Evans, MacNeil, & Micsinszki, 2005; Romp et al., 2014; Rush, Waldrop, Mitchell, & Dyches, 2005). Alternatively, RNs returning to school

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confront a number of inhibitors and barriers. Multiple personal and professional role

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demands, limited resources and educational costs, fear and lack of confidence, lack of recognition of past accomplishments and education, negative previous educational

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experiences, no reward for continuing education (e.g., increased pay), lack of knowledge of benefits and opportunities associated with obtaining a BSN, lack of employer support,

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proximity to retirement age, and educational program-related barriers (e.g., class schedule)

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can be barriers(Altmann, 2011; Brossard & White, 2014; Delaney & Piscopo, 2004;

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Gillespie & Langstrom, 2014; Duffy et al., 2014; Landry et al., 2012; Megginson, 2008; Munkvold, Tanner, & Herinckx, 2012; Murphy et al., 2006; Romp et al., 2014; Sportsman &

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Allen, 2011; Villarruel, Canales, & Torres, 2001). Motivators and barriers to continuing education have been primarily examined individually and descriptively, although there is evidence that they are multidimensional. Using a sample of working nurses in Ireland, Murphy et al. (2006) developed a questionnaire consisting of both potential motivators and inhibitors to continuing education. The authors found numerous factors among the set of questions. For the motivators, two factors were identified: job-related and personal. The job-related construct is thought to tap into how returning to school would increase a person’s professional development in the field of nursing. The personal motivators construct is the motivation

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ACCEPTED MANUSCRIPT necessary to feel an increased sense of competence and importance as a nurse. For the inhibitors, three factors were identified: time-related, outcome-related, and employer-

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related. The time-related construct is believed to tap into the inhibitors associated with the

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amount of time available for both work and personal obligations if one returned to school. The employer-related construct taps the perception of a lack of support from employers

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when deciding to return to school.

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While a variety of motivators and inhibitors have been found to impact nurses decisions to return to school, the impact of job satisfaction on likelihood of returning to

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school has not been systematically examined. Only one study was located that addressed job satisfaction and returning to school. Ritchie et al. (2005) found that dissatisfaction with

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work environment did motivate some nurses to further their education.

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Given the preponderance of evidence focused on motivators and inhibitors, this

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study examined the impact of the motivators (personal and professional motivation) and inhibitors (time constraints and employer discouragement) on nurses’ likelihood of

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continuing their education. Moreover, given the dearth of evidence regarding the relationship of job satisfaction to nurses’ likelihood of returning to school, this study also included job satisfaction. The hypothesized relationships among motivators, inhibitors, job satisfaction and likelihood of returning to school are shown in Figure 1. We expected that higher levels of inhibitive forces would create higher levels of personal and professional motivation and a lower level of job satisfaction. Due to consistent evidence that nurses find that time commitment (employer support (or lack thereof), and personal and professional motivation) are significant factors when deciding to return to school, the key hypothesis

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ACCEPTED MANUSCRIPT was that as individuals feel they have less time to devote to school and perceive their employers as not supportive, personal and professional motivation would mediate the

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relationship between the inhibitors and intent to return to school. Job satisfaction was

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expected to have a negative relationship with the intent of returning to school (Zurmehly,

Method

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Sample & Procedure

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2008).

The university IRB approved the study prior to initiation of data collection. This

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analysis is part of a larger study focusing on educational background and mobility of nurses. In the original study, a stratified random sample of registered nurses based on six

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regions of a sparsely populated Western state was selected for a survey sample of 2,086.

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Each of the selected participants was mailed a questionnaire to their home address.

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Participants were instructed to return their completed questionnaires by mail, fax, or to call and give their responses over the phone. Two-hundred and ninety eight participants

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(14.2%) did not have a forwarding address and were not sent another questionnaire packet. Four participants asked not to be included in the study. A total of 796 nurses completed the questionnaire for a response rate of 38.2%. The response waves for the 796 nurses were as follows: 50.6% of participants completed the packet during the first mailing, 35.2% completed the packet during the second mailing, and 14.3% completed the packet during the third mailing. The vast majority (99.5%) returned their completed packet by mail. The 796 nurses in the original study represent 15.3% of the 5,212 registered nurses working in Wyoming in 2014 when the survey was done.

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ACCEPTED MANUSCRIPT For this analysis, , only those nurses employed full-time or part-time (35 hours or less) in health care were included in this analysis, which resulted in 142 participants being

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excluded. A total of 159 participants were removed from the analysis because they

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indicated that they did not know if they planned to return to school or did not respond to the question. Due to the low response rate of the first and second waves of mailings, a

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shorter questionnaire was used in the third mailing in the larger study. Because this

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shorter version excluded questions used in this analysis, 94 participants who completed the shorter version were excluded for this analysis. Finally, missing data on the

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questionnaire led to the removal of 96 participants. After all exclusion criteria were imposed, the sample for this analysis comprised 305 participants (see Table 1 for sample

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reduction methodology).

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Measures

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Demographic information was collected on current employment, occupation, marital status, annual household income, and educational attainment. The motivators and

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inhibitors questions from Murphy et al. (2006) were included in the questionnaire. Participants answered the questions based on the following instructions: “Using a scale from 1 to 3 where 1 means ‘Not at all Influential’ and 3 means ‘Very Influential,’ please circle the response that best describes how you feel about the influence of each of the following statements has on your thoughts of returning to school (or not).” A complete list of the motivators and inhibitor items and their categorization is presented in Table 2. Murphy et al. (2006) found five factors among the motivators and inhibitors: professional motivation, personal motivation, time constraints, employer discouragement, and outcomes. One limitation of the motivators and inhibitors scale was

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ACCEPTED MANUSCRIPT the authors did not specify which questions loaded on the four factors we chose for our analysis. We also did not include the outcome-related inhibitor in our factor structure as all

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items were theoretically thought to be a part of the other four constructs. One question

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used in Murphy et al. was dropped from the analysis (“caring responsibilities”) as it was deemed too general and many participants commented that they did not understand how

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to respond. Cronbach’s alphas for the four factors used in this study are as follows:

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personal motivation (.84), professional motivation (.90), time constraints (.80) and employer discouragement (.73).

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Job satisfaction was assessed using 13 items ranging from satisfaction with salary to autonomy and work environment. Individuals answered the items based on the following

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instructions: Using a scale from 1 to 5 where 1 means “Very Dissatisfied” and 5 means

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“Very Satisfied”, please circle the response that best describes how you feel about each of

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the following statements at your primary nursing position.” Sample items include: “Physical work environment”, “Interactions with physicians”, “Quality of patient care where

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you work”, and “Interactions with patients.” The Cronbach’s Alpha was .86 indicating good internal consistency for these items as a reliable measure of job satisfaction. The items were averaged across individuals and had a mean of 3.77, SD = .64. One item was used to assess the individual’s intent on returning to school. Respondents were asked, “Do you plan to return to school to further your education?” The responses were in the form of year intervals. The intent was assessed with the following four options: Yes, within the next 3 years, Yes, in 3 to 5 years, Yes, in more than 5 years, and No. Reponses were coded from 0 (No) to 3 (Yes, within the next 3 years) with higher numbers indicating a more immediate goal of returning to school.

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ACCEPTED MANUSCRIPT Data Analysis In the present study, hypotheses were tested using a structural equation modeling

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technique (LISREL 9.1) to analyze the relationship between dependent and independent

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variables in the model as shown in Figures 1 and 2. In structural equation modeling a variance-covariance matrix is analyzed using maximum likelihood estimation procedure.

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In the first part of the analysis, a confirmatory factor analysis (CFA) was performed to

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assess the measurement model’s goodness-of-fit. CFA is used to understand the underlying factor structure of a set of measures based upon an already defined theory.

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To assess model fit, multiple goodness-of-fit indices were examined. The software provides several goodness-of-fit indices and also provides suggested modification indices

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to improve model fit. Goodness-of-fit indices used in the present study included: χ2

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likelihood ratio, standardized root mean squared residual (SRMR), comparative fit index

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(CFI), and the root mean square error of approximation (RMSEA). The χ2 ratio and the SRMR are measures of absolute fit, which evaluates the overall discrepancy between

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observed and implied covariance. A χ2 ratio with a p-value of greater than .05 indicates good fit. However, one limitation of the χ2 ratio is that it is vulnerable to sample size with a higher sample size increasing the statistical significance. SRMR is included in the present analysis to further evaluate absolute fit. A SRMR less than or equal to .08 indicates good absolute fit. Parsimonious fit indices (e.g., RMSEA) evaluate the overall simplicity of the model by taking into account the number of variables estimated. A RMSEA value of less than or equal to .06 indicates reasonable fit. Finally, incremental fit indices (e.g., CFI) evaluate the model’s absolute or parsimonious fit relative to a baseline model (null model). A CFI of less than .90 indicate lack of incremental fit A CFI between .90 and .95 indicate

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ACCEPTED MANUSCRIPT reasonable fit while values greater than .95 indicate good fit (Hu & Bentler, 2009). In CFA, goodness-of-fit indices are dependent upon sample size and power. Generally, there should

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be 5-10 participants for every measured (observed) indicator (Grimm & Yarnold, 2005). In

Results

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Demographic Statistics

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the 19 measured variables used as shown in Figure 2.

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this study, 305 participants were used in the analysis indicating adequate sample size for

Table 3 shows the demographic characteristics of the participants included in the

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analysis. As seen in Table 3, 45.2% had less than a bachelor’s degree in nursing, 75.7% were employed full-time, and over half (56.7%) had a primary position of a staff nurse. The

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majority of the sample was female (93.1%) and White/Caucasian (94.8%). A significant

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percentage (88.6%) indicated they had a household income of $50,000 or more a year

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(85.3%). The average age was 46.4 years (SD = 12.1 years). Confirmatory Factor Analysis

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To evaluate the measurement model of the motivator and inhibitor scales, we used a maximum likelihood estimation procedure. The initial measurement model showed average to poor goodness-of-fit (SRMR = .05, RMSEA = .08, CFI = .91). The software provides suggested modification indices to improve model fit. Five error terms between variables were suggested to be allowed to covary. Error terms that covary (correlate) are thought to “overlap” such that they measure something in common that is not accounted for by the model specification. The five error terms allowed to covary were theoretically reasonable given the nature of the indicators (see Table 2 for a description of the items). For example, quicker identification of concerns and issues in the profession (Quick) may

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ACCEPTED MANUSCRIPT also lead to greater levels of collaboration and knowledge sharing (Collaborate). After allowing error terms to covary, the model fit well with the data (see Figure 2). All

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standardized factor loadings were significant at the .001 level and above .40, meaning the

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items factored significantly in relation to their specified construct. Structural Model

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The main goal of this study is to examine the impact of motivators (professional and

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personal motivation), inhibitors (time constraints and employer discouragement) and job satisfaction on intent to return to school. . In order to test the hypotheses outlined in the

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introduction, a structural equation model (SEM) approach was employed. SEM uses both observed and unobserved characteristics (e.g., job satisfaction, personal motivation) to

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predict other characteristics (e.g., intent to return to school).

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The average scaled score for job satisfaction was used as a single indicator, given a

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fixed value of 1, and had the error term fixed to zero. This method was also completed for the single item indicator for intent to return to school. The variance and covariances of the

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latent constructs were free to vary. The five error covariances added to the measurement model were allowed to covary in the structural model. Figure 3 shows the hypothesized unstandardized structural model. For simplicity the measurement model is excluded from the figure. The hypothesized model was found to adequately fit the data without any further modification. The CFI fell within the reasonable range (.94). All paths were statistically significant at the p < .05 level. All paths were in the expected direction except for the path from professional motivation to intent to return to school.

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ACCEPTED MANUSCRIPT On the basis of our estimated paths, as perceived employer discouragement increased, personal motivation (.42) and professional motivation (.43) increased while job

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satisfaction (-.35) decreased. The estimated paths from time inhibition indicated that as

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perceived time constraints increased, professional motivation (.26) and personal motivation (.34) increased. As hypothesized, as job satisfaction increased intent to return

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to school decreased (-.29) indicating that as nurses enjoy their job, they are less likely to

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see returning to school as necessary. For both motivators, the paths to intent to return to school were significant but with different effects. As personal motivation increased (2.04),

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the intent to return to school increases. However, as professional motivation increased (a higher level of professional commitment) nurses were less likely to return to school. The

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direct path from time constraints to intent to return was positive and statistically

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significant (.20). The direct path from employer discouragement to the intent to return was

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negative indicating that as perceived employer discouragement on returning to school increased the intent to return to school (-.62) decreased.

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Several indirect paths should be noted. As employer discouragement increased through both types of motivation and job satisfaction, the likelihood of indicating intent to return to school increased.1 It should be noted that this indirect pathway (.54) was slightly lower than the direct effect of employer discouragement on intent to return. Also, the indirect effect was positive (compared to the negative direct effect) which indicates that as motivation increases and job satisfaction decreases due to employer discouragement, the more likely an individual intends to return to school. Further, as time constraints increased

This effect was calculated by adding .42 x 2.04, -.35 x -.29, and .43 x -.98 from the three possible pathways in the estimated model for a total indirect effect of .54 for employer discouragement on intent to return to school. 1

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ACCEPTED MANUSCRIPT both types of motivation increased leading to an indirect increase in the intent to return to school.2 Contrary to hypothesized effects, the motivators and job satisfaction did not fully

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Discussion

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mediate the relationship between inhibitors and intent to return to school.

The goal of this study was to examine the impact of motivators (professional and

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personal motivation), inhibitors (time constraints and employer discouragement) and job

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satisfaction on intent to return to school. Consistent with the findings of Murphy et al. (2006), who identified the main barrier to returning to school as lack of employer support,

return to school was supported.

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the hypothesis that employer discouragement had a significant negative effect on intent to

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Perceived time constraints had a slightly positive effect on returning to school and

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was statistically significant. A number of studies, including Delaney and Pope (2004),

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Megginson (2008), Munkvold et al. (2012), Murphy et al. (2006), and Sportman and Allen (2011), have found time and work-family balance a barrier to returning to school.

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However, generally these have been qualitative and/or descriptive studies asking nurses about barriers to returning to school. The findings of this study suggest that although time constraints are perceived to be barriers to returning to school, these barriers do not completely inhibit returning to school (Warren & Mills, 2009). As hypothesized, motivation and job satisfaction have a positive mediating effect between time and employer inhibition and intent to return. As noted earlier, little research has addressed the impact of job satisfaction on returning to school. In this study, as job

This effect was calculated by adding .34 x 2.04 and .26 x -.98 from the two possible pathways in the estimated model for a total indirect effect of .44 for time constraints on intent to return to school. 2

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ACCEPTED MANUSCRIPT satisfaction increased, returning to school was less likely, which is consistent with the findings of Ritchie et al. (2005).

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The hypothesis that professional motivation had a positive relationship with intent

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to return was not supported. The negative effect of this relationship may indicate that the role of professional motivation in returning to school is multidimensional. On the one

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hand, nurses identify professional growth as a key motivator for returning to school. Rush

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et al. (2005) found that although nurses returning to school already felt professional in their nursing roles, they also felt that they fell short as professionals because of lack of

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preparation, career mobility and/or credibility. This gap was a key motivator for returning to school. On the other hand, nurses do not necessarily require further formal education as

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a mechanism for professional advancement. Orsolini-Hain (2012) interviewed nurses who

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were not considering continuing their education and found that they valued work

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experience over academic preparation and felt that there were possibilities for advancement without formal education. These nurses also felt that the lack of distinction

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between nurses with ASN and BSN degrees in role, skill level and status in patient care was a significant factor in their decisions not to return to school. Similarly, some nurses question the value of additional formal education believing the BSN education will not impact their direct patient care (Zuzelo, 2001). In this study, the relationship between the inhibitors and intent to return was not fully mediated by motivation and job satisfaction. The direct relationship between the inhibitor variables and intent to return remained statistically significant. These results indicate that even though motivation and job satisfaction play a role in overcoming

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ACCEPTED MANUSCRIPT perceived employer discouragement and time constraints, the intent to return is still directly affected by these perceived barriers.

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Several limitations of the present study should be noted. The age of the sample was

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relatively high (a mean of 46.4 years). Individuals who are in the middle of their careers or who are nearing retirement age may not be either inhibited or motivated to return to

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school due to impending workforce exit. Replicating the findings using a younger sample

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should provide additional evidence of the relationships presented in the current study. There were also significantly more females than males which limit the generalizability

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across genders. The response rate is also of note. Badger and Werrett (2004) completed a review of nursing journal articles setting an acceptable response rate of 60%. The authors

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found that there was a considerable range reported (35% to 81%). A low response rate

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could lead to inaccurate conclusions due to response bias. Due to a relatively low response

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rate (38.2%), caution should be taken when interpreting results. Finally, the motivators and inhibitors scale was developed in Ireland and may not have completely captured

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motivators and inhibitors in US nurses. Further study is needed in several areas. First, the relationship between professional motivation and return to school needs further qualitative and quantitative analyses. Second, the sample in this study was from a sparsely populated western state with a predominantly white/Caucasian population and further research using urban and more diverse samples is important. Do motivators, inhibitors and job satisfaction impact return to school similarly in urban and diverse nurses? The study has several interesting implications for nursing education and practice. It is important to recognize that some of the factors in this study can more likely be impacted

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ACCEPTED MANUSCRIPT by educational programs and/or employers than others (e.g., aspects of personal motivation such as self-confidence). Clearly, mechanisms to help nurses with the demands

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of work and family while attending school are important (e.g., flexible programs provided

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through a variety of distance approaches). Moreover, educational programs should develop curricula that enhance personal motivation, such as by facilitating development of

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self-confidence and commitment to lifelong learning and development of knowledge and

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skills. For employers, this study highlights the importance of employer support (e.g., financial support and employer recognition) in decisions to return to school. However, this

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study also found that job satisfaction can lower nurses’ desires to return to school. Clearly, providing incentives to return to school while maintaining satisfied nurses is important.

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Balancing these two important employment factors deserves more research to help guide

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employers in optimally supporting their nurses to return to school.

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ACCEPTED MANUSCRIPT References Altmann, T. K. (2011). Registered nurses returning to school for a bachelors degree in

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nursing: Issues emerging from a meta-analysis of the research. Contemporary Nurse,

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39(2), 256-272.

Badger, F., & Werrett, J. (2005). Room for improvement? Reporting response rates and

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recruitment in nursing research in the past decade. Journal of Advanced Nursing, 51,

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502-510.

Broussard, L., & White, D. (2014). School nurse intention to pursue higher education.

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Journal of School Nursing, 30(5), 340-348.

Delaney, C., & Piscopo, B. (2004). RN-BSN programs: Associate degree and diploma nurses’

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perceptions of the benefits and barriers to returning to school. Journal for Nurses in

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Staff Development, 20(4), 157-161.

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Duffy, M. T., Friesen, M. A., Speroni, K. G., Swengros, D., Shanks, L. A., Walter, P. A., & Sheridan, M. J. (2014). BSN completion barriers, challenges, incentives, and

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strategies. Journal of Nursing Administration, 44(4), 232-236. Gillespie, A. B., & Langston, N. (2014). Inspiration of aspirations: Virginia nurse insights about BSN progression. Journal of Professional Nursing, 30(5), 418-425. Grimm, L.G., & Yarnold, P.R. (Eds.). (2005). Reading and understanding multivariate statistics. Washington, DC: APA. Hu, L., & Bentler, P.M. (2009). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6, 1-55.

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ACCEPTED MANUSCRIPT Institute of Medicine (2010). The Future of Nursing. Leading Change, Advancing Health. Washington, DC: National Academies Press.

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Landry, L. L., Orsolini-Hain, L., Renwanz-Boyle, A., Alameida, M., & Holpit, L. (2012). The

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nursing educational highway in action: Results of a needs assessment and the formation of a collaborative workgroup. Nursing Education Perspectives, 33(4), 274-

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277.

of Nursing Management, 16, 47-55.

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Megginson, L. A. (2008). RN-BSN education: 21st century barriers and incentives. Journal

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Munkvold, J., Tanner, C. A., & Herinckx, H. (2012). Factors affecting the academic progression of associate degree graduates. Journal of Nursing Education, 51(4), 232-

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235.

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Murphy, C., Cross, C., & McGuire, D. (2006). The motivation of nursing to participate in

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continuing professional education in Ireland. Journal of European Industrial Training, 30, 365-384.

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Orsolini-Hain, L. (2012). Mixed messages: Hospital practices that serve as disincentives for associate degree-prepared nurses to return to school. Nursing Outlook, 60, 81-90. Ritchie, L. A., Macneil, M., Evans, M., & Micsinszki, S. (2005). “Surviving”: Registered nurses’ experiences in a baccalaureate nursing programs. International Journal of Nursing Scholarship, 2(1), Article 15. Romp, C. R., Kiehl, E. M., Bickett, A., Bledsoe, S. F., Brown, D. S., Eitel, S. B., & Wall, M. P. (2014). Motivators and barriers to returning to school: RN to BSN. Journal for Nurses in Professional Development,30(2), 83-86.

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ACCEPTED MANUSCRIPT Rush, K. L., Waldrop, S., Mitchell, C., & Dyches, C. (2005). The RN-BSN distance educational experience: From educational limbo to more than an elusive degree. Journal of

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Professional Nursing, 21(5), 283-292.

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Sportman, S., & Allen, P. (2011). Transitioning associate degree nursing students to the Bachelor of Science in Nursing and beyond: A mandate for academic partnerships.

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Journal of Professional Nursing, 27, e20-e27.

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Villarruel, A. M., Canales, M., & Torres, S. (2001). Bridges and barriers: Educational mobility of Hispanic nurses. Journal of Nursing Education, 40(6), 245-251.

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Warren, J. I., & Mills, M. E. (2009). Motivating registered nurses to return for an advanced degree. Journal of Continuing Education in Nursing, 40(5), 200-207.

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Zurmehly, J. (2008). The relationship of educational preparation, autonomy, and critical

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39(10), 453-460.

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thinking to nursing job satisfaction. Journal of Continuing Education in Nursing,

Zuzelo, P. R. (2001). Describing the RN-BSN learner perspective: Concerns, priorities, and

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practice influences. Journal of Professional Nursing, 17, 55-61.

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Table 1. Description of Sample Size Reduction Method Based on Response Rate and Researcher-Imposed Reductions Sample Size Step Reduction Initial Survey Sample 2,086 Missing forwarding address -288 Participants requested to be excluded -4 A Total Response Rate of 38.2% 796 Nurses not employed part-time or full-time in the healthcare industry -142 Participants did not Indicate their intent to return to school -159 Participants completed the shorter questionnaire -94 Missing data -96 Total Sample Size Used 305

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Table 2. Factor Descriptions and First-Order Factor Loadings for the Motivator and Inhibitor Measurement Model Identifier in Item Figure 1 Personal Motivation 1. Increased levels of self-confidence Confidence 2. Commitment to a process of learning and continuous updating of knowledge and skills Commit 3. Greater levels of career satisfaction Satisfaction 4. Higher levels of professional respect from colleagues Respect

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Professional Motivation 1. Increased likelihood of influencing changes in health care 2. Greater levels of awareness of personal and professional values 3. Quicker clarity and understanding of your own role within the organization 4. Possibilities for networking leading to career progression 5. Greater levels of collaboration and knowledge sharing 6. Quicker identification of concerns and issues within the profession 7. Increased expectation of promotion

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Time Inhibition (Constraints) 1. Time required to attend an educational program 2. Balancing the demands of home, work, and study 3. Return to education more challenging than expected 4. Time required to study and complete assignments

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Employer Inhibition (Discouragement) 1. Lack of recognition from employer 2. Lack of study leave provided by employer 3. Lack of ability to transfer learning to the workplace 4. Lack of financial support from employer

Influence Aware Clarity Network Collaborate Quick Promotion

Time Balance Challenge Study

Recognition Study_Leave Transfer Finance

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Table 3. Percent Distribution of Education, Employment, and Demographic Characteristics (N = 305) % of % of Variable Total Variable Total Degree Type Sex 6.2% 5.9% Diploma/Vocational Male 39.0% 93.1% Associate's of Nursing Female 38.7% 1.0% Bachelor's of Nursing Unknown 14.4% Marital Status Master's of Nursing 1.6% 8.5% Doctorate in Nursing Single Employment 81.0% Married or Cohabitating 75.7% 9.2% Full-time Divorced/Widowed 24.3% 1.3% Part-time No Answer Pre-Tax Household Primary Position Income 56.7% 2.3% Staff Nurse Less than $30,000 11.1% 9.2% Nurse Manager $30,000 to $49,999 9.5% 20.7% Other, Health Related $50,000 to $69,999 8.5% 29.5% Advanced Practice Nurse $70,000 to $99,999 4.6% 35.1% Nurse Educator $100,000 or More 2.6% 3.3% Nurse Executive No Answer 1.0% Race Nurse Consultant 5.9% 94.8% No Answer White/Caucasian Primary Speciality 5.2% All Other Plans to Return to 14.8% School Acute Care 3.9% 59.0% Adult/Family Health No 7.9% 5.6% Geriatric/Gerontology Yes, in more than 5 years 1.6% 8.9% Home Health Yes, in 3 to 5 years 3.3% 26.6% Maternal/Child Health Yes, within the next 3 years 10.5% Medical/Surgical 1.6% Oncology 20.0% Other, Health Related 2.6% Pediatrics/Neonatal 3.3% Primary Care 3.0% Psychiatric/Mental Health 7.5% Public Health 2.6% Rehabilitation 6.2% School Health 1.6% Women's Health 4.4% All Other 5.2% No Answer

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ACCEPTED MANUSCRIPT Highlights Impact of motivators, inhibitors and job satisfaction on return to school examined.

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First study to examine motivators, inhibitors and job satisfaction together.

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Perceived employer discouragement directly impact intent to return to school. Time constraints directly impact intent to return to school

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Motivation and job satisfaction contributed to a nurse’s intent to return to school

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