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Nursing student's expectations for their future profession and motivating factors – A longitudinal descriptive study from Sweden
Journal Pre-proof Nursing Student's expectations for their future profession and motivating factors– A longitudinal descriptive study from Sweden
Lindberg Maria, Carlsson Marianne, Kristofferzon Marja-Leena, Skytt Bernice
Engström
Maria,
PII:
S0260-6917(19)30792-0
DOI:
https://doi.org/10.1016/j.nedt.2019.104218
Reference:
YNEDT 104218
To appear in:
Nurse Education Today
Received date:
22 May 2019
Revised date:
8 August 2019
Accepted date:
14 September 2019
Please cite this article as: L. Maria, C. Marianne, E. Maria, et al., Nursing Student's expectations for their future profession and motivating factors– A longitudinal descriptive study from Sweden, Nurse Education Today(2019), https://doi.org/10.1016/ j.nedt.2019.104218
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© 2019 Published by Elsevier.
Journal Pre-proof Title: NURSING STUDENT’S EXPECTATIONS FOR THEIR FUTURE PROFESSION AND MOTIVATING FACTORS– A LONGITUDINAL DESCRIPTIVE STUDY FROM SWEDEN Running title: Nursing students’ professional expectations Word count: 5138 (abstract included)
Corresponding author: Lindberg Maria, PhD, RN, Centre for Research and Development, Uppsala University / Region Gävleborg SE 801 88 Gävle, Sweden AND Department of Public Health and Caring Sciences Uppsala University, Box 564 SE 751 22 Uppsala, Sweden tel: +4626 156559 [email protected]
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Carlsson Marianne, Professor, Faculty of Health and Occupational Studies Department of Caring Sciences SE 801 76 Gävle, Sweden AND PhD, Professor, Department of Public Health and Caring Sciences Uppsala University, Box 564 SE 751 22 Uppsala, Sweden [email protected]
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Engström Maria, PhD, RN, Professor, Faculty of Health and Occupational Studies Department of Caring Sciences SE 801 76 Gävle, Sweden AND PhD, RN, Associate Professor, Department of Public Health and Caring Sciences Uppsala University, Box 564 SE 751 22 Uppsala, Sweden AND PhD, RN, Professor, Department of Nursing Sciences, Faculty of Medicine and Health, Lishui University, China [email protected]
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Kristofferzon Marja-Leena, PhD, RN, Senior lecturer, Faculty of Health and Occupational Studies Department of Caring Sciences SE 801 76 Gävle, Sweden AND PhD, RN, Associate Professor, Department of Public Health and Caring Sciences Uppsala University, Box 564 SE 751 22 Uppsala, Sweden [email protected]
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Skytt Bernice, PhD, RN, Senior lecturer, Faculty of Health and Occupational Studies Department of Caring Sciences SE 801 76 Gävle, Sweden AND PhD, RN, Associate Professor, Department of Public Health and Caring Sciences Uppsala University, Box 564 SE 751 22 Uppsala, Sweden [email protected]
Sources of funding: No financial or other relationships exists that might lead to a conflict of interest. Funding was obtained from Region Gävleborg and University of Gävle. The funding sources had no involvement in study design, in the collection, analysis and interpretation of data, in the writing process, or in the decision to submit the manuscript for publication.
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Abstract Background: The shortage of registered nurses is a global concern. Motives to become registered nurses can be to help others, altruism, personal development and career security. Motives in combination with student expectations regarding the role are not explored. Objective: To describe students’ motives to become registered nurses and their expectations regarding their future profession.
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Design: A longitudinal descriptive design with a qualitative approach was used to follow nursing students in the beginning, during and at the end of their education.
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Participants and setting: A purposive sampling of a group with initially 75 students starting a three year nursing program at a university in Sweden.
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Methods: A study specific questionnaire with open-ended questions was used in the beginning, during and the end of the students’ education. At data collection two and three, a copy of the earlier answers was attached. Data were analyzed using manifest and latent content analysis.
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Results: An important profession with career opportunities, interesting duties and team work were described. Students expected diversified duties, possibilities for development and work satisfaction. Increased concerns regarding their upcoming work life was described at the end of the education.
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Conclusion: The students had a positive understanding of the profession and perceived their forthcoming role as interesting. The leading role of coordinating patient care was more comprehensive than expected. Supportive conditions and well planned transition periods could strengthen newly graduated nurses in their professional role and could be an important aspect in the future retention of RNs.
Keywords: Expectations, Longitudinal qualitative study, Nursing students, Professional role
Journal Pre-proof BACKGROUND
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The prevailing situation with the shortage of registered nurses (RN) is a global concern that has led to an increased interest to study students’ individual motives to become RNs. Several motives have been identified, e.g. to help others, to make a difference, altruism, a specific personal interest, personal development and career security (Duffield et al., 2004; Wu et al., 2015). However, the aspect of motive in combination with the students’ expectations of their upcoming role has not yet been explored in depth. Wilkes et al. (2014) described nursing students’ perceptions of the qualities of an RN to be related to caring, knowledge/understanding, empathy, work, communication and skills. Undergraduate nursing education aims to support students in their acquisition of the specific knowledge, skills and attitudes needed for the profession (Cronenwett et al., 2007). In this, both healthcare personnel (HCP) and academic staff are important role models for the development of the nursing students own professionalism (Felstead, 2013; Keeling & Templeman, 2013), i.e., a professional identity that is considered a key factor in the RN’s ability to deliver good and safe patient care (Cronenwett et al., 2007). It is well known that a theory-practice gap exists for newly graduated RNs regarding their knowledge of patient safety and practices (Murray et al., 2017), and that strategies in the transition period need to be developed to help them grow into their professional role (Murray et al., 2017; Kumaran & Carney, 2014). The development of professional identity has been identified as a factor that contributes to the newly graduated RN’s ability to handle role stress. Nursing students with higher professional identity levels have shown lower role stress levels (Sun et al., 2016).
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Exposure to health care plays an important role in informing individuals about the field of nursing (McKenna et al., 2017). Nursing students get experience from nursing practice and their upcoming role through their clinical training, where the development of their professional identity is influenced by the behaviors and attitudes of the HCP they meet (Felstead, 2013). So what happens to the nursing students’ initial motives to become RNs and their expectations regarding their upcoming role after clinical training and their exposure to health care and the work life of RN’s? Can the students’ expectations in some way be connected to the prevailing nursing shortage?
METHOD
Aim To describe students’ motives to become registered nurses and their expectations regarding their future profession.
Design
Journal Pre-proof A longitudinal descriptive design with a qualitative approach was used to follow nursing students in the beginning, during and at the end of their education.
Sample A purposive sampling of a group with 75 students starting a three year nursing program was asked if we could follow them during their education. At the second data collection, 53 of the students still attended the program. At the third, 47 students remained, but 17 did not participate in the data collection (Table 1).
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Table 1 about here
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Data collection
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The students were given a form with study specific open-ended questions in August 2011 at the beginning of the program (five questions), again in May 2012 after the start of their clinical training (three questions), and in May 2014 at the end of the program (seven questions) (Box 1). The questions in the form were based on the identified knowledge gap regarding students motivation and expectations to become a RN. When the class was scheduled for activities at the university, they were given information about the study and received the questionnaire with a stamped addressed envelope. The students could write their answers/thoughts at that time or later if they preferred.
Data analysis
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With the initial data collection we also collected data on age and any previous experience in health care. With data collection two and three, a copy of the student’s earlier answers was attached to the questionnaire. The students were asked to read and reflect upon their earlier answers before writing their current thoughts. Two questions regarding the students choise of their future workplace has not been analysed. Box 1 about here
The written answers were transcribed into a text file and subjected to both manifest and latent content analysis (Patton, 2015). To understand and become familiar with the comprehensive material, the texts were read several times. The authors ML and BS preformed the analysis together. Based on the aim of the study, one data collection at the time, the texts were analysed and the meaning units were identified. The meaning units were thereafter abstracted and given codes that were in the next step sorted into subcategories and categories. The entire material was taken into consideration during the analysis process, as were the similarities and differences in the codes and categories. An underlying meaning of the material, a theme, was identified during the analysis process. The author, MC, read through the text and analysis process to ensure no area that addressed the aim had been overlooked. The analysis process was discussed among all of the authors until consensus was reached. All authors have extensive experience from qualitative analysis.
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Ethics There were no risks to the students’ health, so according to Swedish law, 2003; 460, no approval by an ethics review board was required. Permission to conduct the study was granted by the academic department head of the nursing school. A Senior lecturer that was not involved in any of the courses in the students’ program collected the return envelopes in the classroom. The students received written and oral information about the study aim and they were informed that they could terminate their voluntary participation at any time.
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FINDINGS
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The findings are presented in the one theme, three categories and eight subcategories. The first and the second categories include the three perspectives ‘in the beginning’, ‘during’ and ‘at the end’ of the nursing program. The third category represents the perspective ‘at the end’ of the nursing program (Table 2). Citations from the students written answers are provided togheter with the students identification number and age at the first data collection, e.g. (S1, 19 years).
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Table 2 about here
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A conviction their profession will be important, will lead to development and be enriching, yet concerned the demands in the workplace could be too great was the main theme. The content in the subcategories portray the students’ expectations of an important profession with career opportunities, interesting duties and team work. Furthermore, the students expected to have diversified duties that gave work satisfaction and good opportunities for professional and personal development. The participants gradually developed an awareness regarding their upcoming profession. A more nuanced perception of the role that incorporated concerns over their coming work life was described at the end of their education. Meaningful profession with career opportunities and the possibility to make a difference Interest to help others and the characteristics of the profession In the beginning they described a desire to work in a team and to work with people in need. To be of importance to patients was central in the majority of the descriptions. Their reasons for choosing the profession was influenced by previous experience in health care and inspiration from relatives working as RNs. The students wanted to be RNs because they expected a meaningful profession they could be proud of, that had a high level of responsibility, and was inspiring, diverse and rewarding. “Meaningful and important work, so that I can have a sense of satisfaction with what I do.“ (S36, 24 years) Fascination with the human body, to acquire more knowledge about nursing care, to improve health care and do research were also described as driving forces. During the education the motivation to work with people and do something meaningful was still important. From their clinical experience while training, they found the diversity in the role, the
Journal Pre-proof interaction with HCP, patients and their relatives to be rewarding. “As a RN, a person feels they have done something really worthwhile and rewarding.” (S11, 21 years) The clinical training confirmed that the profession they chose was correct, and they found that as RNs they could actually influence nursing care. At the end, their motivation was to provide good patient care, although they perceived it a challenge to identify patient’s individual needs when leading the nursing care. To be part of and to make a difference in everyday work was important, and it was considered as working for a good cause. “To be able to make a difference and help people every day.” (S30, 19 years) Work duties with diversity and working in areas of interest made the role exciting.
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A profession with possibilities In the beginning the students reported that professional and personal growth could be achieved through different and difficult care situations. For students that had worked as nursing assistants, the education was considered a natural step to develop competence. To specialize in various areas or work as a manager was described as positive. Opportunities to work in different countries, in nonprofit organizations, in areas outside health care or pursue postgraduate studies were also mentioned. “A profession with many possibilities; you can choose the country, sector, specialty, a first step in the career.” (S3, 21 years)
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During the education the possibilities for enrichment and further development remained, although at that point recognized as opportunities for lifelong learning and continuous growth personally and professionally. The students maintained that the profession has many educational possibilities as well as opportunities to work worldwide. “The profession allows the possibility for further education and a broadening of one’s competence within their professional field.” (S4, 20 years)
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At the end the students envisioned a constant challenge in their coming role. They felt excited about their upcoming role working with technology and acute care situations. Improvement of health care and working for a higher professional status was emphasized. The risk for unemployment was considered minimal. “To develop and work with something you are passionate about.” (S3, 21 years) To contribute to good team work for good care in a challenging workday Close cooperation within the team In the beginning the students expected to meet different persons in different and difficult situations. Predominantly positive meetings were expected, however, unpleasant situations could be encountered. They anticipated close and constructive team work with open communication and open-minded as well as respectful colleagues that helped each other deliver good care. “Be able to cooperate and communicate in order to give the best care possible.” (S20, 21 years) The students described what they perceived as a hierarchy among HCP as well as patients, with the RNs somewhere in the middle, which could lead to tension. They hoped that a respectful and constructive work climate would make them feel confident and appreciated, which would lead to free-flowing cooperation, well-being in the work place and respectful contacts with the patients.
Journal Pre-proof During the education they experienced many positive encounters with patients, their relatives and colleagues; but some were unpleasant. The students expressed their concern that HCP teams needed to cooperate and have respectful communication that keeps the patients in focus. “Meet each other with respect and dignity to achieve the best possible care results.” (S20, 21 years) The students expected to be part of a work group with positive, enjoyable and agreeable colleagues.
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At the end they were disappointed because some of the RNs did not assume personal responsibility or work for the best of the patients and society. The hierarchy was not as distinct as expected; on the contrary they experienced close cooperation between the different professions, although it varied with different units. That the RN had such a vital and involved leading role in patient care, i.e., coordinating patient transfers between units and care levels and the work in the team was unexpected. “I didn’t expect the RN would have such a leading role in the care…//…a nurse is much more than I thought.” (S19, 20 years)
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Develop your own abilities to provide good care and achieve job satisfaction In the beginning they assumed that while giving good patient care, they would have a variety of duties that would satisfy and inspire them as well as promote their development. A driving force for them was to help patients together with other team members or individually. They described how they worked hard in their daily work and strived to be competent and professional in their contact with both patients and colleagues, as that would result in a sense of satisfaction and meaning. “You learn new things every day as a RN, both about yourself and others.” (S59, 20 years)
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During the education, giving patients personal support was described as important as was having social competence, being respectful and empathic. Meeting patients’ individual needs was emphasized. Being professional with patients, their relatives, and colleagues gave work satisfaction. Moreover, the feeling of satisfaction was related to an important work role that included paper work, rounds, and support to nursing assistants. The students described their contentment when they had good knowledge of the patients, which helped them give good care. “I have continuity with my patients and know how things have progressed.” (S23, 25 years) Meeting persons with various problems and facing positive and negative situations were considered to be educational and interesting. They wanted their work days to be busy with enough time for all patients since that made them feel fulfilled professionally and personally.
At the end, they realized how their work as a RN could lead to the future development of patient care. Being content with the work they performed was important for work satisfaction. Patient care was described as more multifaceted and emotional than expected. Inpatient care was something some of the students did not want to work with since time spent with direct patient care was so limited. “I don’t want to work in a unit where the main task is to dispense medications and do documentation.” (S30, 19 years) They were humble regarding the RN’s role and concluded that as new graduates they could not be perfect. “My demands on myself have decreased and I have become more humble, even though I thought it would have been the other way around.” (S13, 26 years) Challenging pace and many different duties
Journal Pre-proof In the beginning they encountered varying and intense work days with many duties in, e.g. administration and documentation, which demanded responsibility. Unpredictable work days with varying intensities and duties were described as attractive and exciting. They expected their work days to be hectic as well as physically and psychologically demanding, but there was concern the days could be overly challenging and errors could result. Supportive colleagues were described to be of importance during moderately stressful and emotional work days, and to enhance well-being and satisfaction. “Educational, satisfying, but even sometimes rather demanding work both mentally and physically.” (S51, 28 years)
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During the education, they wanted unpredictable, exciting and satisfying work days. These were no longer the hectic and stressful work days described in the beginning. Delegation and prioritization was reported to be needed to handle the vast amount of duties. Interruptions in work were perceived to make the work more stressful and fragmented. A described dilemma was not being able to give good patient care due to the lack of time and fear of exhaustion caused by unfavorable conditions and stress. “I think I will come to like it, but at times I experience frustration over the unfavorable conditions, stress and situations that cannot be altered.” (S8, 20 years)
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At the end, their perception of the RN’s responsibility was greater than expected and they feared it could be rather demanding. They perceived the RN’s workload to be much heavier than in the beginning. As a new RN they described how their lack of work routines could make the workday very stressful. “Difficult with the time constraints and too many patients, you feel that some patients receive a lower priority, and that doesn’t feel good.” (S7, 20 years) RNs had much more medication administration and administrative duties, and less direct patient care than expected. Working closely with patients and using computers was described as something positive by some students. Some described how administrative work could be accomplished more efficiently, and the time saved could be allocated to direct patient care. What was learned in nursing school was described to differ greatly from what was actually practiced in health care. Concerns of not having enough support and of not managing Doing right in a demanding, high pace profession with many duties Good patient contact and enough time to establish good care relationships was described as important. They expressed a desire and ambition to satisfy patient needs by providing individualized care and to continuously improve patient care. As future RNs, they expressed the importance of being determined when opposing unreasonable demands from management. Important aspects were good working conditions, a reasonable salary and a work environment that prevents work related injuries. They perceived the handling of the stress encountered with severely ill patients and a workload with too many patients that increased the risk for mistakes to be a major challenge. Additionally, they found it difficult to keep work separate from their personal lives, i.e., not processing work related issues when off duty. “Focus is often placed on the purely medicinal due to a lack of time even though you want to work with care giving.” (S8, 20 years) Difficulties being in a new professional role and work group They expressed how working as a RN has its difficulties since they need to know about the different healthcare entities and their context, they need to act ethically and professionally, and they need to
Journal Pre-proof be self-assured and trust their own knowledge; while remembering they are new in their role. They perceived that RN’s should lead and coordinate patient care, be proactive and handle unforeseen and difficult situations that can involve dissatisfied, demanding and disrespectful persons. They must be able to handle many types of equipment, be skillful, knowledgeable and well informed. Team work was perceived as something fundamental although challenging. The students were concerned about the difficulties that can develop with the group dynamics while coordinating the team work, especially as newly graduated RNs. “Colleagues who oppose rather than cooperate.” (S25, 26 years) DISCUSSION
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To work as an RN was perceived as meaningful and the profession was one to be proud of. In earlier studies, nursing was described as meaningful and altruistic (Price et al., 2013). Professional pride among recently graduated nurses is described as emanating from patient relationships and recognition and confirmation from colleagues for providing high-quality care (Sneltvedt & Bondas, 2016). The core reason for choosing the profession was expressed by the students as “to help others” by making a difference (Price et al., 2013; Wilkes et al., 2015; Wu et al., 2015). According to Wu et al. (2015), another main reason was a personal interest in health care. Altruism and important duties are major driving forces behind the desire to study to become a RN in the present study as well as in earlier research from different countries. The students envisioned the RN’s role would include a diversity of duties as well as necessary and meaningful interactions with others. A conception of nursing described by students was that nursing “had it all”, i.e., it was rewarding, secure and diverse (Price et al., 2013).
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The students perceived that their upcoming role would be characterized by challenges and lifelong learning with many educational possibilities. Nursing can be considered a stepping stone to other careers (Wilkes et al., 2015). Not only is the risk for unemployment considered minimal, but the profession provides opportunities to work in various clinical specialties worldwide. As an RN, job security is assured (Price et al., 2013; Wilkes et al., 2015; Wu et al., 2015) since the profession includes several careers in one, has different sectors to work in, and offers the opportunity to travel (Duffield et al., 2004; Price et al., 2013). To provide good patient care was described as a motivator and at the same time a challenge when the care the patient desires does not agree with what the HCP identify as appropriate. Newly graduated nurses identified the leadership of the team as a key in providing good patient care, and they strived to take full control using leadership that encompass the ability to guide, support, and appraise the situation (Ekström & Idvall, 2015). In doing so, the knowledge and skills needed to provide good patient care are as complex as the nursing students anticipated in the present study since it includes both clinical and leadership skills. During the education, the students expected to be exposed to many different and sometimes challenging experiences as well as constructive team work. Communication has been highlighted as being important in providing quality patient care, as it is one way to build trust. Good communication skills are important when participating professionally in a multidisciplinary team (Wilkes et al., 2014). In the present study, a prerequisite for feeling confident and appreciated was a constructive and collegial work climate. At the end of the education, the students related that the RN’s role was not
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what they originally expected it would be. Foremost, it was their leading role in coordinating patient care that was more comprehensive than expected. In Wilkes et al. (2014) the nursing students at the end of their education also perceived a need for better skills in management, leadership, and organization than they anticipated in the beginning. This was also one of the competencies that graduating nursing students rate as the lowest (Gardulf et al., 2016). Newly graduated nurses in Ekström and Idvall (2015) also emphasized the challenges and importance of nursing leadership. Owing to the complexities in their coming role, the students feared difficulties in their day-to-day work such as leading and coordinating nursing care and taking the leading role in teamwork. Inexperience and not trusting their own judgement caused newly graduated nurses difficulties. The importance of an empowering work situation was emphasized since they lack authority in the work group (Sneltvedt & Bondas, 2016). Démeh and Rosengren (2015) reported that clinical leadership was found to be an important skill in order to fully grasp the RN’s role. It is understood that proficient nursing leadership is of importance for well-functioning team work in which nursing is acknowledged and what is best for the patient is the focus. The students experienced the RN’s role to be more multifaceted and emotional than expected. Michalec et al. (2013) and Keeling and Templeman (2013) describe how clinical experience facilitated the participants understanding and comprehension of their upcoming role. Therefore, to ease the process of the transition period it is important for the employer to take responsibility and carefully plan it.
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A risk for an overly challenging work life where errors could occur owing to lack of time, severely ill patients, heavy workloads and demanding responsibilities was experienced. The students wanted reasonable demands from management, responsibility for a reasonable number of patients, and a work environment that prevents work related injuries. With the present situation in Swedish health care, where there is a shortage of RNs to work in the hospitals, it is not surprising that as a consequence the RNs are responsible for a large number of patients, some of which are severely ill. A large number of patients per RN can easily be what the nursing students described as a strained work situation with demands that are too high. Aiken et al. (2011) reported that there is a relationship between nurse staffing levels and improved patient outcomes when the work environment is perceived as good. The students feared that unfavorable conditions as well as stress would lead to exhaustion. At the same time, they wanted their working day to be busy, but with enough uninterrupted time to care for the patients in a professional and a secure way. Michalec et al. (2013) reported that burnout was considered by students to be inevitable, which is something the study participants also predicted after their clinical training. The students expressed how as newly graduated RNs they lacked work routines, which contributed to the stress in their workdays. Blomberg et al. (2016) and Kumaran and Carney (2014) reported that newly graduated nurses experience high levels of stress, and concluded that they benefit from adequate support during the transition period. Study limitations The students might have been influenced by the data collection procedure that allowed them time to reflect and provide their answers with a senior lecturer present during scheduled class time. The analysis of the students’ already condensed written material was challenging, i.e. to not overinterpret the written text. In the analysis process it was not possible for the authors to perform any kind of follow-up to clarify any problems encountered with reading or understanding the written
Journal Pre-proof text. Therefore, two authors performed the analysis together to ensure consistency throughout the analysis. Conclusion
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The students had a positive understanding of the profession and perceived their upcoming role as interesting. Within the profession are many opportunities and good job security. During the education, the students recognized the complexity and challenges involved in the role. At the end of the education they realized that they had to master nursing care as well as coordinate the patient care team work. The students expressed a concern over their upcoming role as an RN based on their experiences during clinical training. It is important that first line managers are sensitive to the newly graduated nurse’s challenges and have an awareness of how to provide supportive measures in nursing practices, routines and leadership. At an organizational level, in for example hospitals, the upper management’s attitudes and readiness to find a sustainable approach to support newly graduated nurses during their transition period is of strategic importance and could benefit from close collaboration with the nursing school’s directors. Supportive conditions and well planned transition periods could strengthen newly graduated nurses in their professional role and could be an important aspect in the future retention of RNs.
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Sources of funding: No financial or other relationships exists that might lead to a conflict of interest. Funding was obtained from Region Gävleborg and University of Gävle. The funding sources had no involvement in study design, in the collection, analysis and interpretation of data, in the writing process, or in the decision to submit the manuscript for publication.
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Wu, L. T., Lopez, V. & Liaw, S. Y. (2015). Why not nursing? A systematic review of factors influencing career choice among healthcare students. International Nursing review, 62, 547-562. Doi: 10.1111/inr.12220
Journal Pre-proof Table 1. Characteristics of the nurse students.
Theme
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Table 2. Overview of theme, categories and subcategories.
During 53 53 (100) 24.1 (18-45) # 18 28 7 40 (75.5) #
Category
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To contribute to good team work for good care in a challenging workday
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Concerns of not having enough support and of not managing
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- Interest to help others and the characteristics of the profession - A profession with possibilities
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A conviction their profession will be important, will lead to development and be enriching, yet concerned the demands in the workplace could be too great
Subcategory During
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Beginning Meaningful profession with career opportunities and the possibility to make a difference
End 47 30 (63.8) 24.3 (18-45)# 13 12 5 23 (76.6)#
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Beginning Available for inclusion 75 Number of participants (%) 74 (98.7) Age mean (range) 24.4 (18-45) Age group 18-20 29 21-29 33 30-45 12 Previous experience in health care n (%) 58 (78.4) # Information collected with initial data collection.
- Close cooperation within the team - Develop your own abilities to provide good care and achieve job satisfaction - Challenging pace and many different duties
- Doing right in a demanding, high pace profession with many duties - Difficulties being in a new professional role and work group
Box 1. Questions in the study specific form. At the beginning and during the program
At the end of the program
Questions Identification A Age A Previous work experience in health care Why do you want to be a registered nurse? How do you envision your future professional life as an RN? Describe how you think your work day will have been. Identification B What care facility are you going to work in? B What made you choose that care facility? What is it that has given you the motivation to work as a nurse? In your future profession as a nurse, what do you think your challenges will be? When you think back to the expectations and conceptions you had of the nurse’s role – how does it agree with how you see it today? Which expectations have you been able to identify? Which expectations have you needed to reconsider? Is there anything else you would like to convey regarding your upcoming work as a registered nurse that we have not asked about?
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only stated at the first data collection, in the beginning of the program
B
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the question was not analysed owing to the different level of abstraction in the written answers
Lindberg Maria, Carlsson Marianne, Kristofferzon Marja-Leena, Skytt Bernice
Engström
Maria,
PII:
S0260-6917(19)30792-0
DOI:
https://doi.org/10.1016/j.nedt.2019.104218
Reference:
YNEDT 104218
To appear in:
Nurse Education Today
Received date:
22 May 2019
Revised date:
8 August 2019
Accepted date:
14 September 2019
Please cite this article as: L. Maria, C. Marianne, E. Maria, et al., Nursing Student's expectations for their future profession and motivating factors– A longitudinal descriptive study from Sweden, Nurse Education Today(2019), https://doi.org/10.1016/ j.nedt.2019.104218
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
© 2019 Published by Elsevier.
Journal Pre-proof Title: NURSING STUDENT’S EXPECTATIONS FOR THEIR FUTURE PROFESSION AND MOTIVATING FACTORS– A LONGITUDINAL DESCRIPTIVE STUDY FROM SWEDEN Running title: Nursing students’ professional expectations Word count: 5138 (abstract included)
Corresponding author: Lindberg Maria, PhD, RN, Centre for Research and Development, Uppsala University / Region Gävleborg SE 801 88 Gävle, Sweden AND Department of Public Health and Caring Sciences Uppsala University, Box 564 SE 751 22 Uppsala, Sweden tel: +4626 156559 [email protected]
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Carlsson Marianne, Professor, Faculty of Health and Occupational Studies Department of Caring Sciences SE 801 76 Gävle, Sweden AND PhD, Professor, Department of Public Health and Caring Sciences Uppsala University, Box 564 SE 751 22 Uppsala, Sweden [email protected]
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Engström Maria, PhD, RN, Professor, Faculty of Health and Occupational Studies Department of Caring Sciences SE 801 76 Gävle, Sweden AND PhD, RN, Associate Professor, Department of Public Health and Caring Sciences Uppsala University, Box 564 SE 751 22 Uppsala, Sweden AND PhD, RN, Professor, Department of Nursing Sciences, Faculty of Medicine and Health, Lishui University, China [email protected]
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Kristofferzon Marja-Leena, PhD, RN, Senior lecturer, Faculty of Health and Occupational Studies Department of Caring Sciences SE 801 76 Gävle, Sweden AND PhD, RN, Associate Professor, Department of Public Health and Caring Sciences Uppsala University, Box 564 SE 751 22 Uppsala, Sweden [email protected]
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Skytt Bernice, PhD, RN, Senior lecturer, Faculty of Health and Occupational Studies Department of Caring Sciences SE 801 76 Gävle, Sweden AND PhD, RN, Associate Professor, Department of Public Health and Caring Sciences Uppsala University, Box 564 SE 751 22 Uppsala, Sweden [email protected]
Sources of funding: No financial or other relationships exists that might lead to a conflict of interest. Funding was obtained from Region Gävleborg and University of Gävle. The funding sources had no involvement in study design, in the collection, analysis and interpretation of data, in the writing process, or in the decision to submit the manuscript for publication.
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Abstract Background: The shortage of registered nurses is a global concern. Motives to become registered nurses can be to help others, altruism, personal development and career security. Motives in combination with student expectations regarding the role are not explored. Objective: To describe students’ motives to become registered nurses and their expectations regarding their future profession.
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Design: A longitudinal descriptive design with a qualitative approach was used to follow nursing students in the beginning, during and at the end of their education.
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Participants and setting: A purposive sampling of a group with initially 75 students starting a three year nursing program at a university in Sweden.
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Methods: A study specific questionnaire with open-ended questions was used in the beginning, during and the end of the students’ education. At data collection two and three, a copy of the earlier answers was attached. Data were analyzed using manifest and latent content analysis.
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Results: An important profession with career opportunities, interesting duties and team work were described. Students expected diversified duties, possibilities for development and work satisfaction. Increased concerns regarding their upcoming work life was described at the end of the education.
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Conclusion: The students had a positive understanding of the profession and perceived their forthcoming role as interesting. The leading role of coordinating patient care was more comprehensive than expected. Supportive conditions and well planned transition periods could strengthen newly graduated nurses in their professional role and could be an important aspect in the future retention of RNs.
Keywords: Expectations, Longitudinal qualitative study, Nursing students, Professional role
Journal Pre-proof BACKGROUND
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The prevailing situation with the shortage of registered nurses (RN) is a global concern that has led to an increased interest to study students’ individual motives to become RNs. Several motives have been identified, e.g. to help others, to make a difference, altruism, a specific personal interest, personal development and career security (Duffield et al., 2004; Wu et al., 2015). However, the aspect of motive in combination with the students’ expectations of their upcoming role has not yet been explored in depth. Wilkes et al. (2014) described nursing students’ perceptions of the qualities of an RN to be related to caring, knowledge/understanding, empathy, work, communication and skills. Undergraduate nursing education aims to support students in their acquisition of the specific knowledge, skills and attitudes needed for the profession (Cronenwett et al., 2007). In this, both healthcare personnel (HCP) and academic staff are important role models for the development of the nursing students own professionalism (Felstead, 2013; Keeling & Templeman, 2013), i.e., a professional identity that is considered a key factor in the RN’s ability to deliver good and safe patient care (Cronenwett et al., 2007). It is well known that a theory-practice gap exists for newly graduated RNs regarding their knowledge of patient safety and practices (Murray et al., 2017), and that strategies in the transition period need to be developed to help them grow into their professional role (Murray et al., 2017; Kumaran & Carney, 2014). The development of professional identity has been identified as a factor that contributes to the newly graduated RN’s ability to handle role stress. Nursing students with higher professional identity levels have shown lower role stress levels (Sun et al., 2016).
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Exposure to health care plays an important role in informing individuals about the field of nursing (McKenna et al., 2017). Nursing students get experience from nursing practice and their upcoming role through their clinical training, where the development of their professional identity is influenced by the behaviors and attitudes of the HCP they meet (Felstead, 2013). So what happens to the nursing students’ initial motives to become RNs and their expectations regarding their upcoming role after clinical training and their exposure to health care and the work life of RN’s? Can the students’ expectations in some way be connected to the prevailing nursing shortage?
METHOD
Aim To describe students’ motives to become registered nurses and their expectations regarding their future profession.
Design
Journal Pre-proof A longitudinal descriptive design with a qualitative approach was used to follow nursing students in the beginning, during and at the end of their education.
Sample A purposive sampling of a group with 75 students starting a three year nursing program was asked if we could follow them during their education. At the second data collection, 53 of the students still attended the program. At the third, 47 students remained, but 17 did not participate in the data collection (Table 1).
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Table 1 about here
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Data collection
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The students were given a form with study specific open-ended questions in August 2011 at the beginning of the program (five questions), again in May 2012 after the start of their clinical training (three questions), and in May 2014 at the end of the program (seven questions) (Box 1). The questions in the form were based on the identified knowledge gap regarding students motivation and expectations to become a RN. When the class was scheduled for activities at the university, they were given information about the study and received the questionnaire with a stamped addressed envelope. The students could write their answers/thoughts at that time or later if they preferred.
Data analysis
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With the initial data collection we also collected data on age and any previous experience in health care. With data collection two and three, a copy of the student’s earlier answers was attached to the questionnaire. The students were asked to read and reflect upon their earlier answers before writing their current thoughts. Two questions regarding the students choise of their future workplace has not been analysed. Box 1 about here
The written answers were transcribed into a text file and subjected to both manifest and latent content analysis (Patton, 2015). To understand and become familiar with the comprehensive material, the texts were read several times. The authors ML and BS preformed the analysis together. Based on the aim of the study, one data collection at the time, the texts were analysed and the meaning units were identified. The meaning units were thereafter abstracted and given codes that were in the next step sorted into subcategories and categories. The entire material was taken into consideration during the analysis process, as were the similarities and differences in the codes and categories. An underlying meaning of the material, a theme, was identified during the analysis process. The author, MC, read through the text and analysis process to ensure no area that addressed the aim had been overlooked. The analysis process was discussed among all of the authors until consensus was reached. All authors have extensive experience from qualitative analysis.
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Ethics There were no risks to the students’ health, so according to Swedish law, 2003; 460, no approval by an ethics review board was required. Permission to conduct the study was granted by the academic department head of the nursing school. A Senior lecturer that was not involved in any of the courses in the students’ program collected the return envelopes in the classroom. The students received written and oral information about the study aim and they were informed that they could terminate their voluntary participation at any time.
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FINDINGS
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The findings are presented in the one theme, three categories and eight subcategories. The first and the second categories include the three perspectives ‘in the beginning’, ‘during’ and ‘at the end’ of the nursing program. The third category represents the perspective ‘at the end’ of the nursing program (Table 2). Citations from the students written answers are provided togheter with the students identification number and age at the first data collection, e.g. (S1, 19 years).
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A conviction their profession will be important, will lead to development and be enriching, yet concerned the demands in the workplace could be too great was the main theme. The content in the subcategories portray the students’ expectations of an important profession with career opportunities, interesting duties and team work. Furthermore, the students expected to have diversified duties that gave work satisfaction and good opportunities for professional and personal development. The participants gradually developed an awareness regarding their upcoming profession. A more nuanced perception of the role that incorporated concerns over their coming work life was described at the end of their education. Meaningful profession with career opportunities and the possibility to make a difference Interest to help others and the characteristics of the profession In the beginning they described a desire to work in a team and to work with people in need. To be of importance to patients was central in the majority of the descriptions. Their reasons for choosing the profession was influenced by previous experience in health care and inspiration from relatives working as RNs. The students wanted to be RNs because they expected a meaningful profession they could be proud of, that had a high level of responsibility, and was inspiring, diverse and rewarding. “Meaningful and important work, so that I can have a sense of satisfaction with what I do.“ (S36, 24 years) Fascination with the human body, to acquire more knowledge about nursing care, to improve health care and do research were also described as driving forces. During the education the motivation to work with people and do something meaningful was still important. From their clinical experience while training, they found the diversity in the role, the
Journal Pre-proof interaction with HCP, patients and their relatives to be rewarding. “As a RN, a person feels they have done something really worthwhile and rewarding.” (S11, 21 years) The clinical training confirmed that the profession they chose was correct, and they found that as RNs they could actually influence nursing care. At the end, their motivation was to provide good patient care, although they perceived it a challenge to identify patient’s individual needs when leading the nursing care. To be part of and to make a difference in everyday work was important, and it was considered as working for a good cause. “To be able to make a difference and help people every day.” (S30, 19 years) Work duties with diversity and working in areas of interest made the role exciting.
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A profession with possibilities In the beginning the students reported that professional and personal growth could be achieved through different and difficult care situations. For students that had worked as nursing assistants, the education was considered a natural step to develop competence. To specialize in various areas or work as a manager was described as positive. Opportunities to work in different countries, in nonprofit organizations, in areas outside health care or pursue postgraduate studies were also mentioned. “A profession with many possibilities; you can choose the country, sector, specialty, a first step in the career.” (S3, 21 years)
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During the education the possibilities for enrichment and further development remained, although at that point recognized as opportunities for lifelong learning and continuous growth personally and professionally. The students maintained that the profession has many educational possibilities as well as opportunities to work worldwide. “The profession allows the possibility for further education and a broadening of one’s competence within their professional field.” (S4, 20 years)
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At the end the students envisioned a constant challenge in their coming role. They felt excited about their upcoming role working with technology and acute care situations. Improvement of health care and working for a higher professional status was emphasized. The risk for unemployment was considered minimal. “To develop and work with something you are passionate about.” (S3, 21 years) To contribute to good team work for good care in a challenging workday Close cooperation within the team In the beginning the students expected to meet different persons in different and difficult situations. Predominantly positive meetings were expected, however, unpleasant situations could be encountered. They anticipated close and constructive team work with open communication and open-minded as well as respectful colleagues that helped each other deliver good care. “Be able to cooperate and communicate in order to give the best care possible.” (S20, 21 years) The students described what they perceived as a hierarchy among HCP as well as patients, with the RNs somewhere in the middle, which could lead to tension. They hoped that a respectful and constructive work climate would make them feel confident and appreciated, which would lead to free-flowing cooperation, well-being in the work place and respectful contacts with the patients.
Journal Pre-proof During the education they experienced many positive encounters with patients, their relatives and colleagues; but some were unpleasant. The students expressed their concern that HCP teams needed to cooperate and have respectful communication that keeps the patients in focus. “Meet each other with respect and dignity to achieve the best possible care results.” (S20, 21 years) The students expected to be part of a work group with positive, enjoyable and agreeable colleagues.
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At the end they were disappointed because some of the RNs did not assume personal responsibility or work for the best of the patients and society. The hierarchy was not as distinct as expected; on the contrary they experienced close cooperation between the different professions, although it varied with different units. That the RN had such a vital and involved leading role in patient care, i.e., coordinating patient transfers between units and care levels and the work in the team was unexpected. “I didn’t expect the RN would have such a leading role in the care…//…a nurse is much more than I thought.” (S19, 20 years)
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Develop your own abilities to provide good care and achieve job satisfaction In the beginning they assumed that while giving good patient care, they would have a variety of duties that would satisfy and inspire them as well as promote their development. A driving force for them was to help patients together with other team members or individually. They described how they worked hard in their daily work and strived to be competent and professional in their contact with both patients and colleagues, as that would result in a sense of satisfaction and meaning. “You learn new things every day as a RN, both about yourself and others.” (S59, 20 years)
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During the education, giving patients personal support was described as important as was having social competence, being respectful and empathic. Meeting patients’ individual needs was emphasized. Being professional with patients, their relatives, and colleagues gave work satisfaction. Moreover, the feeling of satisfaction was related to an important work role that included paper work, rounds, and support to nursing assistants. The students described their contentment when they had good knowledge of the patients, which helped them give good care. “I have continuity with my patients and know how things have progressed.” (S23, 25 years) Meeting persons with various problems and facing positive and negative situations were considered to be educational and interesting. They wanted their work days to be busy with enough time for all patients since that made them feel fulfilled professionally and personally.
At the end, they realized how their work as a RN could lead to the future development of patient care. Being content with the work they performed was important for work satisfaction. Patient care was described as more multifaceted and emotional than expected. Inpatient care was something some of the students did not want to work with since time spent with direct patient care was so limited. “I don’t want to work in a unit where the main task is to dispense medications and do documentation.” (S30, 19 years) They were humble regarding the RN’s role and concluded that as new graduates they could not be perfect. “My demands on myself have decreased and I have become more humble, even though I thought it would have been the other way around.” (S13, 26 years) Challenging pace and many different duties
Journal Pre-proof In the beginning they encountered varying and intense work days with many duties in, e.g. administration and documentation, which demanded responsibility. Unpredictable work days with varying intensities and duties were described as attractive and exciting. They expected their work days to be hectic as well as physically and psychologically demanding, but there was concern the days could be overly challenging and errors could result. Supportive colleagues were described to be of importance during moderately stressful and emotional work days, and to enhance well-being and satisfaction. “Educational, satisfying, but even sometimes rather demanding work both mentally and physically.” (S51, 28 years)
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During the education, they wanted unpredictable, exciting and satisfying work days. These were no longer the hectic and stressful work days described in the beginning. Delegation and prioritization was reported to be needed to handle the vast amount of duties. Interruptions in work were perceived to make the work more stressful and fragmented. A described dilemma was not being able to give good patient care due to the lack of time and fear of exhaustion caused by unfavorable conditions and stress. “I think I will come to like it, but at times I experience frustration over the unfavorable conditions, stress and situations that cannot be altered.” (S8, 20 years)
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At the end, their perception of the RN’s responsibility was greater than expected and they feared it could be rather demanding. They perceived the RN’s workload to be much heavier than in the beginning. As a new RN they described how their lack of work routines could make the workday very stressful. “Difficult with the time constraints and too many patients, you feel that some patients receive a lower priority, and that doesn’t feel good.” (S7, 20 years) RNs had much more medication administration and administrative duties, and less direct patient care than expected. Working closely with patients and using computers was described as something positive by some students. Some described how administrative work could be accomplished more efficiently, and the time saved could be allocated to direct patient care. What was learned in nursing school was described to differ greatly from what was actually practiced in health care. Concerns of not having enough support and of not managing Doing right in a demanding, high pace profession with many duties Good patient contact and enough time to establish good care relationships was described as important. They expressed a desire and ambition to satisfy patient needs by providing individualized care and to continuously improve patient care. As future RNs, they expressed the importance of being determined when opposing unreasonable demands from management. Important aspects were good working conditions, a reasonable salary and a work environment that prevents work related injuries. They perceived the handling of the stress encountered with severely ill patients and a workload with too many patients that increased the risk for mistakes to be a major challenge. Additionally, they found it difficult to keep work separate from their personal lives, i.e., not processing work related issues when off duty. “Focus is often placed on the purely medicinal due to a lack of time even though you want to work with care giving.” (S8, 20 years) Difficulties being in a new professional role and work group They expressed how working as a RN has its difficulties since they need to know about the different healthcare entities and their context, they need to act ethically and professionally, and they need to
Journal Pre-proof be self-assured and trust their own knowledge; while remembering they are new in their role. They perceived that RN’s should lead and coordinate patient care, be proactive and handle unforeseen and difficult situations that can involve dissatisfied, demanding and disrespectful persons. They must be able to handle many types of equipment, be skillful, knowledgeable and well informed. Team work was perceived as something fundamental although challenging. The students were concerned about the difficulties that can develop with the group dynamics while coordinating the team work, especially as newly graduated RNs. “Colleagues who oppose rather than cooperate.” (S25, 26 years) DISCUSSION
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To work as an RN was perceived as meaningful and the profession was one to be proud of. In earlier studies, nursing was described as meaningful and altruistic (Price et al., 2013). Professional pride among recently graduated nurses is described as emanating from patient relationships and recognition and confirmation from colleagues for providing high-quality care (Sneltvedt & Bondas, 2016). The core reason for choosing the profession was expressed by the students as “to help others” by making a difference (Price et al., 2013; Wilkes et al., 2015; Wu et al., 2015). According to Wu et al. (2015), another main reason was a personal interest in health care. Altruism and important duties are major driving forces behind the desire to study to become a RN in the present study as well as in earlier research from different countries. The students envisioned the RN’s role would include a diversity of duties as well as necessary and meaningful interactions with others. A conception of nursing described by students was that nursing “had it all”, i.e., it was rewarding, secure and diverse (Price et al., 2013).
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The students perceived that their upcoming role would be characterized by challenges and lifelong learning with many educational possibilities. Nursing can be considered a stepping stone to other careers (Wilkes et al., 2015). Not only is the risk for unemployment considered minimal, but the profession provides opportunities to work in various clinical specialties worldwide. As an RN, job security is assured (Price et al., 2013; Wilkes et al., 2015; Wu et al., 2015) since the profession includes several careers in one, has different sectors to work in, and offers the opportunity to travel (Duffield et al., 2004; Price et al., 2013). To provide good patient care was described as a motivator and at the same time a challenge when the care the patient desires does not agree with what the HCP identify as appropriate. Newly graduated nurses identified the leadership of the team as a key in providing good patient care, and they strived to take full control using leadership that encompass the ability to guide, support, and appraise the situation (Ekström & Idvall, 2015). In doing so, the knowledge and skills needed to provide good patient care are as complex as the nursing students anticipated in the present study since it includes both clinical and leadership skills. During the education, the students expected to be exposed to many different and sometimes challenging experiences as well as constructive team work. Communication has been highlighted as being important in providing quality patient care, as it is one way to build trust. Good communication skills are important when participating professionally in a multidisciplinary team (Wilkes et al., 2014). In the present study, a prerequisite for feeling confident and appreciated was a constructive and collegial work climate. At the end of the education, the students related that the RN’s role was not
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what they originally expected it would be. Foremost, it was their leading role in coordinating patient care that was more comprehensive than expected. In Wilkes et al. (2014) the nursing students at the end of their education also perceived a need for better skills in management, leadership, and organization than they anticipated in the beginning. This was also one of the competencies that graduating nursing students rate as the lowest (Gardulf et al., 2016). Newly graduated nurses in Ekström and Idvall (2015) also emphasized the challenges and importance of nursing leadership. Owing to the complexities in their coming role, the students feared difficulties in their day-to-day work such as leading and coordinating nursing care and taking the leading role in teamwork. Inexperience and not trusting their own judgement caused newly graduated nurses difficulties. The importance of an empowering work situation was emphasized since they lack authority in the work group (Sneltvedt & Bondas, 2016). Démeh and Rosengren (2015) reported that clinical leadership was found to be an important skill in order to fully grasp the RN’s role. It is understood that proficient nursing leadership is of importance for well-functioning team work in which nursing is acknowledged and what is best for the patient is the focus. The students experienced the RN’s role to be more multifaceted and emotional than expected. Michalec et al. (2013) and Keeling and Templeman (2013) describe how clinical experience facilitated the participants understanding and comprehension of their upcoming role. Therefore, to ease the process of the transition period it is important for the employer to take responsibility and carefully plan it.
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A risk for an overly challenging work life where errors could occur owing to lack of time, severely ill patients, heavy workloads and demanding responsibilities was experienced. The students wanted reasonable demands from management, responsibility for a reasonable number of patients, and a work environment that prevents work related injuries. With the present situation in Swedish health care, where there is a shortage of RNs to work in the hospitals, it is not surprising that as a consequence the RNs are responsible for a large number of patients, some of which are severely ill. A large number of patients per RN can easily be what the nursing students described as a strained work situation with demands that are too high. Aiken et al. (2011) reported that there is a relationship between nurse staffing levels and improved patient outcomes when the work environment is perceived as good. The students feared that unfavorable conditions as well as stress would lead to exhaustion. At the same time, they wanted their working day to be busy, but with enough uninterrupted time to care for the patients in a professional and a secure way. Michalec et al. (2013) reported that burnout was considered by students to be inevitable, which is something the study participants also predicted after their clinical training. The students expressed how as newly graduated RNs they lacked work routines, which contributed to the stress in their workdays. Blomberg et al. (2016) and Kumaran and Carney (2014) reported that newly graduated nurses experience high levels of stress, and concluded that they benefit from adequate support during the transition period. Study limitations The students might have been influenced by the data collection procedure that allowed them time to reflect and provide their answers with a senior lecturer present during scheduled class time. The analysis of the students’ already condensed written material was challenging, i.e. to not overinterpret the written text. In the analysis process it was not possible for the authors to perform any kind of follow-up to clarify any problems encountered with reading or understanding the written
Journal Pre-proof text. Therefore, two authors performed the analysis together to ensure consistency throughout the analysis. Conclusion
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The students had a positive understanding of the profession and perceived their upcoming role as interesting. Within the profession are many opportunities and good job security. During the education, the students recognized the complexity and challenges involved in the role. At the end of the education they realized that they had to master nursing care as well as coordinate the patient care team work. The students expressed a concern over their upcoming role as an RN based on their experiences during clinical training. It is important that first line managers are sensitive to the newly graduated nurse’s challenges and have an awareness of how to provide supportive measures in nursing practices, routines and leadership. At an organizational level, in for example hospitals, the upper management’s attitudes and readiness to find a sustainable approach to support newly graduated nurses during their transition period is of strategic importance and could benefit from close collaboration with the nursing school’s directors. Supportive conditions and well planned transition periods could strengthen newly graduated nurses in their professional role and could be an important aspect in the future retention of RNs.
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Sources of funding: No financial or other relationships exists that might lead to a conflict of interest. Funding was obtained from Region Gävleborg and University of Gävle. The funding sources had no involvement in study design, in the collection, analysis and interpretation of data, in the writing process, or in the decision to submit the manuscript for publication.
Journal Pre-proof REFERENCES Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., & Neff, D. F. (2011). The effects of Nurse Staffing and Nurse Education on Patient Deaths in Hospitals With Different Nurse Work Environments. Medical Care, 49, 1047-1053. Doi: 10.1097/MLR.0b013e3182330b6e Blomberg, K., Isaksson, A-K., Allvin, R., Bisholt, B., Ewertsson, M., Kullen Engström, A., Ohlsson, U., Sundler Johansson, A. & Gustafsson, M. (2016). Work stress among newly graduated nurses in relation to workplace and clinical group supervision. Journal of Nursing Management, 24, 80-87. Doi: 10.1111/jonm.12274
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Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., Sullivan, D. t. & Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55, 122-131. Doi: 10.1016/j.outlook.2007.02.006
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Démeh, W. & Rosengren, K. (2015). The visualization of clinical leadership in the content of nursing education-A qualitative study of nursing students experiences. Nurse Education Today, 35, 888-893. Doi: 10.1016/j.nedt.2015.02.020
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Wu, L. T., Lopez, V. & Liaw, S. Y. (2015). Why not nursing? A systematic review of factors influencing career choice among healthcare students. International Nursing review, 62, 547-562. Doi: 10.1111/inr.12220
Journal Pre-proof Table 1. Characteristics of the nurse students.
Theme
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Table 2. Overview of theme, categories and subcategories.
During 53 53 (100) 24.1 (18-45) # 18 28 7 40 (75.5) #
Category
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To contribute to good team work for good care in a challenging workday
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Concerns of not having enough support and of not managing
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- Interest to help others and the characteristics of the profession - A profession with possibilities
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A conviction their profession will be important, will lead to development and be enriching, yet concerned the demands in the workplace could be too great
Subcategory During
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Beginning Meaningful profession with career opportunities and the possibility to make a difference
End 47 30 (63.8) 24.3 (18-45)# 13 12 5 23 (76.6)#
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Beginning Available for inclusion 75 Number of participants (%) 74 (98.7) Age mean (range) 24.4 (18-45) Age group 18-20 29 21-29 33 30-45 12 Previous experience in health care n (%) 58 (78.4) # Information collected with initial data collection.
- Close cooperation within the team - Develop your own abilities to provide good care and achieve job satisfaction - Challenging pace and many different duties
- Doing right in a demanding, high pace profession with many duties - Difficulties being in a new professional role and work group
Box 1. Questions in the study specific form. At the beginning and during the program
At the end of the program
Questions Identification A Age A Previous work experience in health care Why do you want to be a registered nurse? How do you envision your future professional life as an RN? Describe how you think your work day will have been. Identification B What care facility are you going to work in? B What made you choose that care facility? What is it that has given you the motivation to work as a nurse? In your future profession as a nurse, what do you think your challenges will be? When you think back to the expectations and conceptions you had of the nurse’s role – how does it agree with how you see it today? Which expectations have you been able to identify? Which expectations have you needed to reconsider? Is there anything else you would like to convey regarding your upcoming work as a registered nurse that we have not asked about?
Journal Pre-proof A
only stated at the first data collection, in the beginning of the program
B
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the question was not analysed owing to the different level of abstraction in the written answers