Anna Maria Bosco (MSc)

Curtin University of Technology

Dr Catherine Ward

Curtin University of Technology

Dr Irene Styles

Murdoch University

The motivation to select a tertiary study program is influenced by the long and short term career prospects it may offer. Explored are specific motivations/influences that encourage students to undertake a nursing career. Ford’s (1986) taxonomy of human goals provides the theoretical framework for this study. A major aim was to identity what motivated or influenced the students to embark on a nursing career, and to determine the student’s image of being a nurse and their role within nursing. The study presented in this paper employed a cross sectional approach. A questionnaire was devised and administered to 126 nursing students enrolled in the first semester of a nursing degree. Preliminary findings show three distinct goals/perspectives of self as a nurse emerge: first, altruism, second, the therapeutic relationship being focused on the self rather than the patient, and third, the opportunistic aspirations nursing can provide. Further, the image of nurses and nursing continue to be influenced by the media. Results have implications for nurse education (long and short term) as the motivators/influences identified by participants to undertake nursing appear to be more complex than initially thought. This is especially significant given the current shortage of nurses; therefore these findings should be further explored.

Student nurses,

Image of nursing,

Influences,

Motivation

The worldwide shortage of nurses has attracted much discussion within the nursing profession and nursing literature (Buchan, 1997; Campbell & Dickson, 1996; Cowin, 2001; Glossop, 2001; Jalili-Grenier & Chase, 1997; Marshall, 1989; Smith, 1990; While & Blackman, 1998). The media reminds the community that the current shortfall in individuals who are pursuing nursing as a career and those who are leaving the profession has massive implications for the health care industry (While & Blackman, 1998). To attract more individuals to the profession a positive image of nursing needs to be engendered by nurse education and the general community. According to Bacon and McKendrick (2000), Kiger (1993) and Rossiter and Yam (1998) the stereotypical images of nurse and nursing persist. The nurse is depicted as a battleaxe, a sex symbol or in a subordinate role and handmaiden to the doctor. These persistent images do not serve to encourage young people into the profession and do not indicate the diverse career pathways that are available.

The projection of a positive image of nurses and nursing has been the concern of the profession for some time. Unfortunately the conventional image persists and it is these images that prospective nursing students may retain when seeing themselves as nurses; this factor is of significance to this present study. Recent research, however, reports a change in how the public perceive nurses (Bacon & McKendrick, 2000). Nurses are now viewed as being well-educated and independent thinkers and this perspective may reflect that vision that the nurse is now a major player within a high-tech medical world. Conversely, Cowin (2001) and While and Blackman (1998) assert that girls are moving away from the stereotypical female careers and are becoming more attracted to traditional male occupations. If this were the case, then the nursing profession may be losing a valuable opportunity to recruit future nurses. As the Australian and global population ages it is imperative that action is taken to attract more individuals to nursing and also act to reduce the attrition of future student and qualified nurses (Campbell & Dickson, 1996).

Individuals enter the profession with a strong perception of what it involves and how they will practice, indeed nursing is not only a job but a career, profession or vocation (Kiger,1993; Raatikainen, 1997; Spouse, 2000a). This present study, therefore, will endeavour to identify if these perceptions of nursing are realistic enough to support students through the rigours of a nursing degree program. What might be determined are the expectations and perceptions of future student’s in regard to nursing and the nursing profession. Essentially, this present study could endorse the view of Campbell and Dickson (1996) who propose that strategies be promoted to reduce the attrition rate of student nurses and also Day, et al., (1995) who suggest that nursing educators must foster within students a realistic view of the nursing profession. Adherence to these goals would ensure a constant stream of motivated nurses who possess the preferred professional and clinical competencies for practice (While and Blackman, 1998).

This study explored student nurses’ perception of nursing and themselves as nurses. Also explored was their expectations of themselves as nurses and the nursing profession. Ford’s (1986) taxonomy of human goals was used as a theoretical framework to underpin this study. These goals identity internal or cognitive goals and range from arousal, evaluation, experiential, psychological, social relationship and task goals. The use of a questionnaire can collect data related to the aforementioned goals, however, art as a means of data collection, may help the students to express thoughts, feelings, fears and expectations more graphically (Spouse, 2000a, 2000b). Furthermore, use of art could be a means to explore and identify students’ feelings and anxieties (Styles & Radloff, 2000).

The problem of recruitment of future student nurses is an difficult task. Thus, an aim of this present study is to identify who and what influences the participants decision to select nursing as a career, possible future career path and images and perception of nurses and the nursing profession.

This study explored student nurses’ perceptions of nursing and themselves as nurses. Also investigated was their expectations of themselves as nurses and the nursing profession. Ford’s (1986) taxonomy of human goals was used as a theoretical framework to underpin this study. These goals identify internal or cognitive goals and range from arousal, experiential, psychological a, social relationship and task goals. The use of a questionnaire can collect data related to the aforementioned goals, however, art as a means of data collection, may help the students to express thoughts, feelings, fears, and expectations more graphically (Spouse, 2000a, 2000b; Styles & Radloff, 2000).

This exploratory study involved a cross sectional design using both qualitative and quantitative approaches. A convenience sample of 126 nursing students who were enrolled in Semester 1 of a nursing degree program and 80 students completing their final semester of the program participated in the study. This paper presents the findings related to the semester 1 group only.

The researchers developed a questionnaire following a review of the literature. Included were demographic data and questions which related to students’ images and expectations of becoming a nurse, and of the nursing profession. Other items explored the reasons why nursing was selected as a career path, and possible factors (negative or positive) that might have influenced their choice. Students were also asked to draw a picture of how they saw themselves as a nurse in the future.

Participation in the study was on a voluntary basis. To ensure confidentiality students were advised not identity themselves (i.e. name or student number). Questionnaires were identified numerically - this code number is used when a quote or drawing is presented in the findings.

Demographic data were managed, and statistical analyses carried out using SPSS. Responses to open items within the questionnaire were transcribed, coded and then managed using the Non-numerical Unstructured Data Indexing Searching and Theory Building (NUDh IST 4) software (Richards & Richards, 1994). Ford’s taxonomy of human goals was used to categorise responses to items on goals. Other data were coded according to themes which emerged from the data and which assisted in building a picture of the participants’ images of nurses and nursing and career options.

Of the 140 students enrolled in semester one of the nursing degree course, 126 completed the questionnaire - a response rate of 90%. Of the 126 respondents, 118 (93.7%) were female and 8 (6.3%) male. Ages ranged from 17 to 53 years (m= 21.63 yrs, SD 7.54). In relation to country of origin, 105 (83.3%) participants were Australian and the remainder originated from various countries such as the UK, Asia, and the USA. In total 119 (94.4%) participants were Australian citizens. None, however, were Aboriginal.

Of the 126 participants, 87 (69%) produced a drawing of how they envisaged themselves as a nurse at the present time and in the future. Seven of these drawings were excluded, as they were incomplete. In total, 80 (63.5%) drawings were accepted for inclusion in the study.

Table 1 provides a description of the types of goals the participants identified in relation to seeing themselves as nurses. In decreasing order of frequency of being mentioned by participants, goals included: Evaluation (self efficacy): positive 68 (54%) and negative 13 (10%); Happiness - satisfaction for self and others -self 50, (39.7%) and others 54, (42.9%); Social Validation 54 (43%); Safety (employment) 40 (31.7%); Social Responsibility (altruism) 22 (17.4%); and Arousal (excitement) (20 (16%) participants.

In relation to the 80 (63.5%) students who had drawn a picture which illustrated how they perceived themselves as nurses, 47 (58.8%) drawings reflected the Happiness Gaol. The students portrayed themselves with smiling faces or a "sunshine" representation reflecting enjoyment (see Figures 1).

Figures 1

Participant (41) Participant (36)

Although 22 (17.4%) participants identified a goal of social responsibility (equity and fairness), only five (6.3%) participants represented this goal through their drawings, by depicting for example, a map of a third world country and as a nurse working there (see Figures 2).

A major goal of the participants was career paths (n= 101, 80.2%) and this was interpreted under the category of Task Goals. Travel was identified by a large proportion of participant’s, (n = 35, 27.7%). In contrast, only ten (8%) selected theatre or surgical nursing. Midwifery and paediatrics was a more popular choice. In total, 91 (72.2%) of participants selected either paediatrics or midwifery as a career path.

Figures 2:

Of the 80 (63.5%) participants who completed a drawing, 18 (20.6%) depicted their vision of their future career path. Of these 18 drawing, 13 (72,2%) related to traditional clinical environments and 5 (27.7%) related to either midwifery or paediatrics – supporting the findings on both Happiness and Safety Goals.

Three major influences were identified in the responses to the question on influences on choice of career: the media, relatives, and aspects of nursing. The following section relates to each of these influences.

These results relate to how the media depict nurses and the nursing profession. Thirty-two (25%) participants stated that the media presented a negative view of nursing. In comparison, only 6 (4.8%) participants stated that the media projected a positive perspective.

Despite the negative perspective portrayed by the media, 28 (22%) participants felt that regardless of what the media said about nursing they themselves remained focussed on their chosen career path. This view is illustrated in the following quotes:

The participants were asked if any of their relatives had attempted to influence them to take up nursing as a career. Sixty-two (49.2%) responded that relatives had tried to influence them and 63 (50%) responded that they had not. Of the 62 participants whose relatives had tried to exert influence, an aunt had exerted the most influence (n = 38, 61.3%), followed by the mother (n = 19, 30.6%), and finally, a sister (n = 6, 9.7%).

Seventeen (13.5%) participants mentioned that relatives or friends tried to dissuade them from taking up nursing as a career by highlighting negatives aspects such as pay, conditions and status.

Negative aspects or areas of care mentioned by participants related to specific aspects of care. Twenty-one (16.6%) mentioned death or dying. Another 21 (16.6%) mentioned conditions (for example, pay, shift work, staffing levels), 10 (8%) mentioned an aversion to handling bodily fluids, and 8 (6.3%) the care of the elderly.

From the drawings produced by the participants, it is evident that stereotypical images of nursing persist. Of the 80 drawings representing students’ visions of being a nurse, most showed a hospital-based approach to care (for example, patients in bed bound with IVs in situ, and pregnant women in hospital). Furthermore, 16 (20%) drawings depicted nurses wearing "traditional" nursing clothing and "instruments"; specifically a uniform, starched cap, syringe and stethoscope.

Typically, the participants were predominantly female and in general came from a young age group. Proportionally, the participants were predominately Australian, however, there were no Aboriginal students in the group. Furthermore the participants did not mention any cultural aspects related to care. This finding agrees with those of Omeri and Ahern (1999) who discuss the difficulty in attracting and retaining Aboriginal and Torres Strait Islander student nurses.

The participants identified a limited number of goals. This limitation may be related to the developmental stage of students and their restricted knowledge of what nursing and the nursing profession involves. The two most frequently mentioned goals related to self-efficacy and social validation which suggest that the participants achieve satisfaction for themselves through helping others. It would seem that these two goals are invested with personal happiness and interest, indeed happiness was depicted as a common feature within the drawing created by the students.

The goal of Social Responsibility (equity and fairness) was projected as caring for people in third world countries. This altruistic approach indicates that the students want to help those individuals perceived as less fortunate than themselves. What is significant is that intention to care for the Aboriginal community was not mentioned. Perhaps providing care in a third world environment seems more romantic than caring for Australian minority groups. Furthermore, feelings of self satisfaction derived from providing care in a third world setting reflects not only the opportunity to travel, but also an altruistic approach and reflects the happiness goal related to feelings of self-satisfaction. All these aforementioned factors would fulfil Self-efficacy and Arousal goals. This finding supports that of Hemsley-Brown and Foskett (1999) who found that young people make a career choice based on the enjoyment this employment would give them.

Evaluation gaols relate to behavioural outcome rather than cognitive accomplishments (Ford, 1990). Results show that this group of students wanted to strive to do their best and perform to the best of their ability. This finding related to evaluation goals supports Ferguson (1990) who suggests that satisfaction and fulfilment in one’s career is very important. There was, however, no emphasis on cognition only on behaviour. Safety in employment was often mentioned by the participants and for the purpose of this study, Ford’s Safety goals were interpreted as safety in employment. Participants viewed nursing as a secure career path, which provided consistent opportunity for employment. Perhaps this response reflects global uncertainty in that a person must pursue a career that will provide long-term secure employment. Since nursing is predominantly a female profession there is a provision that women can successfully pursue their career whilst rearing a family. Moreover, there may be a perception that nursing is a "passport" to work and travel - perhaps another avenue of happiness.

Results identified the participant narrow view of the career paths available within nursing. Participants selected the "comfortable areas of care ", such as midwifery and paediatrics. Again, these environments reflect "happy places", thus providing participants with increased self and employment satisfaction. Furthermore, the students may believe they will not encounter any unhappy situations (death and dying patients). It appears these students possess a limited view of the complexities of caring.

Findings from the study also support previous research on how the media can influence individuals who might be considering nursing as a career (Day, et al (1995). Some individuals may reconsider nursing if a negative view of the health care system was reported by the media. At the time these data were collected, the media reported the fragile state of the health care industry, working conditions and the pay demands being made by nurses. Fortunately, however, some participants in this present study indicated that they tried to remain objective to this view and did not allow the media to influence their choice of career.

Findings from this present support those of Bacon and McKendrick’s (2000), Kiger’s (1993) and Rossiter and Yam’s (1998) that the stereotypical images of nurses persist. Images from the drawings included the nurse wearing a starched hat, which has not been worn in Australian for 20 years. In the main, provision of care depicted in the drawings showed nurses caring for patients in a hospital setting. Again, this reflects how health care is portrayed through the media, thereby reinforcing stereotypical images of caring.

In conclusion, findings demonstrate that students enter nursing with a somewhat limited perspective of what the nursing profession can offer as a career path. Essentially, the participants perceived nursing as a means of receiving happiness in the provision of care, from interactions with patients, and travel. Consistent with this happiness perspective is that students tended to select areas of care, such as midwifery and paediatrics. Nursing was also perceived as a means to ensure employment and security; either within Australia or if they elected to travel. However, the altruistic view expressed by some students who wished to help others did not extend to the remote Aboriginal communities of Australia.

Findings from the study suggest that nurse educators must provide a realistic and not a romantic view of nursing. Results suggests, firstly, by persuading the media to present a more realistic and balanced portrayal of nursing could be a primary positive influence for the profession. Secondly, providing more information to schools and presenting talks at schools by role models who reflect the diversity and complexity of the nurses’ world. Attention to these two factors could assist the nursing profession to attract and retain future nursing students and qualified nurses, thus ensuring adequate provision of appropriate health care in a wide range of settings.

Buchan, J. (1997). Heading for a double whammy. Nursing Standard, 11(12): 24-25.