Why Do Young People Choose Nursing as a Career?

Why Do Young People Choose Nursing as a Career?

Pool, Leanne

Introduction

This paper will review the research literature related to young people’s reasons for choosing or rejecting nursing as a career. A critical overview of the literature is presented using a model of decision-making identified by Leach and Zepke (2005) in their systemic review of the literature around the decision-making processes of prospective tertiary students. The relevance of the research literature about nursing recruitment and retention of young people will be explored in relation to the New Zealand and global context. Finally this paper will summarise and draw conclusions from the current literature as well as identify ‘gaps’ in the published literature and make recommendations for the future.

Relevance to nursing recruitment and retention

In 2002, the New Zealand Nursing Council workforce survey found that one-third of the actively practising registered nurses in New Zealand were aged between 40 and 50 years (Ministry of Health, 2003). With an ageing workforce and an ageing population overall it is desirable to encourage younger people to pursue careers in nursing (Marriner Tomey, Schwier, Martickefc. May, 1996).

In the past five years, enrolments in the Whitireia Community Polytechnic Bachelor of Nursing programme have included an average of 15 students under 20 years old per intake – about 21% of the students enrolled each year. Brown and Matthews’ (2003) study on the impact of student debt on nurses found that only 13% of the students surveyed were under 20 years of age and nearly 33% were 40 years and over. While our programme has always targeted mature students, with the ageing workforce we now have a responsibility to recruit more young people into nursing.

We also have a responsibility for the recruitment of young Maori and Pacific peoples as this is the community that our polytechnic serves. In New Zealand, demographics show that in the next 10-15 years the Pacific population leaving school will be a significant economic factor in our society as they will form a large portion of our workforce. To help address the health workforce shortage there is a need to encourage young Pacific people into sciences and ensure they have the necessary qualifications to enter into the health workforce environment (Southwick, 2004).

At a recent Health Workforce Advisory Committee workshop, it was reported that there had not been much improvement in Maori and Pacific students’ uptake of science, or their results, in the past 20 years. This has affected the numbers going on to study health and science at tertiary level, and had an impact on the number of Maori and Pacific peoples working in those sectors (Encouraging Maori, 2005).

Summary and critical review of findings

Leach and Zepke’s (2005) systematic review of the literature presents the way prospective tertiary students make decisions as a model with three stages. This model will be used to summarise and critically review the findings of the literature related to young people’s decision-making about choosing nursing as a career.

Predisposition

The first stage, predisposition, considers family background, parental disposition to tertiary education, degree of self-belief of the student and the nature of the school attended (Leach & Zepke, 2005).

Boyd and McDowall (2003) undertook a New Zealand study that focused on the transition from school for ‘at risk’ students who were mainly Maori (34%) and Pacific people (32%), with little or low qualifications at School Certificate level, from seven low decile schools. This study focused on the predisposition stage of career choice. It explored the decisionmaking processes of the students in relation to family background and the effectiveness of the non-conventional programmes that they were attending on their transition from school. Their findings suggest that a key feature in the decision-making around tertiary education was the importance of how transition support was provided to the students within the programme they were studying. People were identified as an important source of information for transition support, with course teachers being described as ‘whanau members’. Advice from family members’ ‘frames of reference’ or experience was also significant (Boyd &. McDowall, 2003).

Mullis, Mullis and Gerwels’ (1998) study examined the stability of adolescents’ career interests based on the premise that career choices are largely a result of the predisposition stage of decision-making. Significant differences in career choice were found depending on gender and parental occupation. These differences were found to be stable over the three-year period.

A study of Hong Kong high school students (Law & Arthur, 2003) proposed that students’ decisions regarding nursing were also significantly influenced in the predisposition stage by demographic factors such as gender, subject studies, previous academic achievement and mother’s occupation.

Similarly Harrigan, Gollin and Casken (2003) identified the importance of predisposition in terms of cultural influence in career choice. They included community elders and parents, as well as high school students, in their study of Native Hawaiian, Samoan and Filipino students. In focus groups, Native Hawaiian students discussed issues of low self-esteem, while Filipino students were concerned with parental pressure. Samoan students brought up homesickness and environmental stress as factors that influenced career decision-making.

An emic approach analysed the perceptions about the nursing profession, recruitment and retention held by drop-out nursing students, final year high school students and parents in a community in Kuwait (Fatimah, Al-Kanari &. Ajao, 1998). Findings indicated that participants had a societal predisposition against nursing as it was seen as low in status and not a respectable profession in Kuwait. Barriers to recruitment were lack of social support and lack of information about nursing.

The findings of the studies in this section suggest the importance of cultural and societal influences in decision-making for young people from a variety of global perspectives.

Search

The second stage of decision-making, the search stage, occurs when the student begins to seek options for tertiary study. This is based on factors such as the career aspirations and interests of the student, their academic achievement thus far, access to information and contact with tertiary institutions (Leach &. Zepke, 2005). Most of the research reviewed in this paper related to this stage.

Walls (2000) studied the accuracy of vocational knowledge and how this might influence career interests in young children. Findings showed participants favoured occupations with high status, mental requirements, earnings and preparation or training time. Participants seemed to have little understanding of the importance of job availability in relation to choosing a career.

Paa and McWhirter (2000) studied high school students’ perceptions of factors that might influence career aspirations by asking students to rank the importance of personal, background and environmental factors. Results suggest that young people do perceive their career expectations to be affected by factors such as the mother’s influence in the daughter’s career choice, and parents and peers providing information around career choice. Career counsellors ranked low in influence in this study.

Several other studies (Bolan & Grainger, 2005; Blasdell &. HudginsBrewer, 1999; Mignor, Cadenhead &McKee, 2002) explored the influence of the information given by high school counsellors in relation to career choice. In these North American studies, high school guidance counsellors had a favourable perception of nursing as a career but held a narrow view of the role of the nurse as direct caregiver in institutional settings. They also failed to recognise the importance of decision-making skills, leadership and academic ability for today’s nurses.

Other research focusing on young people’s perceptions of nursing as a career included Hemsley-Brown and Foskett’s (1999) study of British young people, which found that only 6% expressed an interest in nursing although many more saw it as a favourable career choice. Students in this study also expressed a stereotypical view of the nurse’s role as one of caring and helping with many responsibilities and tasks related mainly to caring for patients in hospital. Although nursing was ‘well thought of (p. 1347) by students it was seen to lack status and was perceived to be a ‘blue collar workers’ career (p. 1348).

Cohen, Palumbo, Rambur and Mongeon (2004) undertook a replication study to measure middle school students’ perceptions of an ideal career against perceptions of nursing. Their findings were similar to those of the studies of high school guidance counsellors, with nursing perceived as ‘not needing good grades’, having less decision-making and being more ‘hands on’ and ‘busy’ than the ideal career (p. 206).

Rossiter, Bidewell and Chan’s (1998) study of students from a non-English speaking background in Australia saw nursing ranked sixth in career choice overall. Their perceptions focused on nurses obeying doctors’ orders, ‘treating’ patients and focusing on science and technology. Less than 10% of students were in favour of pursuing nursing as a career.

Many studies have been undertaken with nursing students to explore the factors that influenced their decision to choose nursing as a career. In these studies it appears that the main motives for undertaking nursing were the desire for human contact, helping others and job security (Larsen, McGiIl & Palmer, 2003; Rognstad, Aasland & Granu, 2004; Williams, Wertenberger &.Gushuliak, 1997). However, Rognstad’s (2002) earlier study suggests that these desires for human contact and to help others were not exclusively associated with sick people and direct care, as 46% of the students indicated a preference for midwifery or health visitor roles in nursing.

Past experiences with illness, health care work or family members as nurses were also found to be important motives for undertaking nursing (Beck, 2000; Ditommaso, Rheaume, Woodside & Gautreau, 2003; Larsen, McGiIl & Palmer, 2003).

Boughn and Lentini’s (1999) study undertook a grounded theory approach to explore why women choose nursing. They put forward the desire to care for others as a significant construct, but power and empowerment emerged as resounding constructs in this study. Conversely, the researchers believed that the students’ lack of reference to practical motivations for choosing nursing was also an important theme.

The research summarised in this section focuses on perceptions of nursing, career aspirations and motivations towards nursing as a career choice. The majority of the studies were quantitative and correlational in design, using surveys or questionnaires.

Choices

In the third stage of decision-making, choices, the student looks at specific tertiary providers and programmes based on whether they meet entry criteria, whether the right courses are available and whether the rewards and costs are in balance (Leach & Zepke, 2005). Not much research has been carried out in this area.

Harrigan, Gollin and Casken’s (2003) study identified that money and time were seen as difficulties in the transition from high school to nursing education. While those enrolled as nursing students were generally positive about nursing as a career, those outside nursing saw many deterrents.

A New Zealand study of seventh formers (NZUSA, 2003) found that Maori and Pacific students and those from poor districts were less likely to attend tertiary education because of costs such as tuition fees. They were also influenced by the length of study and related costs such as living expenses. Two other studies (Ditommaso, Rheaume, Woodside & Gautreau, 2003; Williams, Wertenberger&Gushuliak, 1997) identified amount of programme choice as a factor in decision-making with the school’s location, reputation, programme quality and campus size seen as important factors.

Two studies (Beck, 2000; Rognstad, 2002) found that nursing was not the first choice of study for many student nurses. Forty-five percent of students in Rognstad’s (2002) study indicated they wanted to study subjects other than nursing. These findings may indicate that choice is being determined by factors such as undemanding entry criteria.

The research for this section is very limited, which may affect the reliability of these conclusions and indicates a need for further study in this area.

Summary of findings and recommendations for the future

Most of the studies suggest that students continue to choose nursing as a career mainly because of their desire for human contact and caring. This is evident in the research that was undertaken in the 1990s at the start of the health reforms (Boughn & Lentini, 1999; Hemsley-Brown & Foskett, 1999; Rossiter, Bidewell & Chan, 1998; Williams, Wertenberger & Gushuliak, 1997). These motives appear not to have changed significantly in the new millennium (Cohen, Palumbo, Rambur & Mongeon, 2004; Larsen, McGiIl &. Palmer, 2003; Rognstad, Aasland & Granu, 2004).

The research relied heavily on descriptive studies using surveys or questionnaires. The majority involved nursing students who had therefore already made the choice of nursing as a career. More qualitative studies of young people, particularly in New Zealand, could help to broaden the understanding of this issue.

The question remains as to why not many young people choose nursing. Could it be that stereotypical images of nurses are a deterrent to many young people? If so, what can be done to change this image of nursing so that we can meet the demands for the nursing workforce with the move towards primary health care (Expert Advisory Group, 2003) ?

Hemsley-Brown and Foskett (1999) suggest that young people tend to exaggerate the negative attributes of options they have not chosen, as a way of justifying to themselves the choice they have already made. Could it be that young people are not choosing nursing as a career simply because it isn’t seen as ‘cool’?

According to Boyd and McDowall (2003) young people need to be flexible and versatile in their career choice. They need to be prepared to have more than one career and they need skills to participate in the knowledge economy.

With these changes, perhaps the skills and knowledge required for a career in nursing need to be promoted as generic skills that would be useful for many careers. Decision-making, leadership and problem-solving were identified in the research as skills that young people sought in ‘ideal’ careers. The challenge is to put together the pieces that will ensure nursing programmes attract and retain students and prepare them for the realities of their chosen profession (Health, Education and Community Services, 2001).

Wieck (2003) describes today’s 20-something generation (Generation Y) as wanting as much as possible, as fast as possible. They do not plan to work their way up the ladder as they have seen their parents do, but rather see each job as a stepping stone to their next achievement. It seems that parents and families have a significant influence on young people’s career choice. Leach and Zepke (2005) found that parents exert powerful influence on decisions, particularly at the predisposition and search phases. Further research in this area from different paradigms would help to gain a better understanding of this influence.

In New Zealand, the promotion of tertiary education, and particularly nursing, to Maori and Pacific young people seems vital as they will form a significant workforce in the next 20 years (Encouraging Maori, 2005). Perna (as cited in Leach & Zepke, 2005) found that ethnic groups saw the enrichment of their social and cultural capital, rather than academic ability or job opportunities, as a major reason for beginning tertiary education.

This could be particularly true for Maori and Pacific young people who feel it is their duty to undertake a career in nursing for the benefit of their people even though they may not have the academic preparation to do so. It may be that the Bachelor of Nursing (Pacific) programme at Whitireia Community Polytechnic will enable these young people to be successful in nursing in a way that is different from traditional mainstream nursing education.

The lack of research in New Zealand (with no specific studies addressing why New Zealand young people may not choose nursing) signals a need for local study into this area. Spoonley (1999) suggests that this type of research needs to be undertaken by the ethnic groups involved.

Conclusion

The literature suggests that young people’s decision-making is a complex process that is influenced by their predisposition towards tertiary education, their search for career options and the choices available to them. Few young people seem to view nursing as an ideal career option. This suggests that further research needs to be undertaken in this area to explore the reasons why nursing is rejected as a career choice. The recruitment and retention of young people, particularly Pacific people, is an issue for nursing in New Zealand and around the world. The future of the nursing profession may depend on it.

References

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Leanne Pool (RN, BSN, Dip Tertiary Teaching, MPhil Candidate) is currently the Programme Leader of Undergraduate Studies at the Whitireia Community Polytechnic Nursing Centre of Learning. She wrote this article as part of her Master’s research study which will explore why young people choose or reject nursing as a career.

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