Author: Raines, Deborah A
Date published: December 7, 2010
A recent projection by workforce analysts has indicated that the current shortfall in the number of nurses needed to provide care in the United States (US) is expected to increase to more than 500,000 by the year 2025 (Buerhaus, Staiqer, & Auerbach, 2008). The introduction of the accelerated baccalaureate program in nursing was designed as a curricular innovation to enroll more students in nursing programs so as to meet workforce needs. Accelerated baccalaureate programs are designed for adults who have already completed a baccalaureate or graduate degree in a non-nursing discipline and who desire to become a nurse; they are the quickest route to licensure as a registered nurse (RN). These programs have experienced tremendous growth and popularity, and are now offered in 43 states plus the District of Columbia and Puerto Rico (American Association of Colleges of Nursing [AACN] 2008a). In 2007 there were 205 accelerated baccalaureate programs enrolling 9,938 students, a significant increase over the 90 programs available in 2002 (AACN, 2008b). At four-year colleges and universities, new accelerated baccalaureate nursing programs far outpace all other types of new entry-level nursing programs (Raines &Taalaireni. 2008).
The projected RN shortage and work force needs have generated interest in nursing as a career; nursing has become an attractive option for second degree students seeking a career change. Previous research has demonstrated that second degree/career changing students enrolled in accelerated programs are successful as students, as National Council Licensure Examination-RN candidates, and in the transition to independent professional practice (Raines, 2007). The American Association of Colleges of Nursing (AACN) Issue Bulletin, 2005 American Association of Colleges of Nursing. (AACN) Issue Bulletin, Accelerated programs: The fast-track to careers in nursing Available at: http://www.sciencedirect.com.ezproxy.fau.edu/science? ob=RedirectURL& method=externObiünk& locator=url& cdi=6916& DlusSion=%2B& targetURL=http%253A% 252F%252Fwww.aacn.nche.edu%252FPublications%252Fissues%252FAug02.htm (2005) Accessed July 25, 2006. American Association of Colleges of Nursing Issue Bulletin (2008a) reported that accelerated students excel in class and that employers prize these graduates. However, there is limited literature about what attracts second degree/career changing students to the study of nursing. This article will report the findings of a study asking what factors attract individuals with a degree in a non-nursing discipline to seek a career in nursing. I will begin with a review of literature describing reasons for choosing nursing as a career, and a description of the method used to analyze the stories written by the prospective students explaining why they desired to earn a nursing degree. This will be followed by a presentation of findings, along with a discussion of the findings and the implications of the findings for educators and employers.
Knowledge of what motivates the second degree/career changing individual to pursue a career in nursing is important for both educational and practice settings. An understanding of what motivates the second degree/career changing learner is needed by academic institutions and faculty to recruit students and to provide learning experiences that meet the needs of these students. In the practice setting, knowledge of what motivates these students to become nurses is essential for recruiting and retaining these individuals in the nursing workforce.
People choose a career for many reasons. A cluster of published studies has reported that traditional undergraduate students often identify personal experiences as a motive for becoming a nurse. One common experience referred to by the individuals in these studies was that of observing the contributions nurses made during their hospitalizations or the hospitalization of a loved one (Larsen, McGiII, & Palmer, 2003; Prater & McEwen, 2006). In Prater and McEwen's (2006) cross-sectional study the students identified nurses as being caring and compassionate; a majority of the participating students "decided to go to nursing school while in high school or college and chose nursing because they had a desire to help others" (p. 63). Having a family member as a healthcare professional, especially a mother who was a nurse, was another commonly found personal motive for choosing nursing (Barriball & While, 1996: Dockery & Barns, 2005). Furthermore, intrinsic factors, such as the desire to help or care for others and to contribute to society have been reported as dominant factors influencing career choices (Bouohn. 2001: Newton. Kelly. Krenser. Jolly. & Billett. 2009: Prater & McEwen. 2006: Zybero & Berry, 2005). Many of the students in these studies indicated they were 'called' to nursing or were 'born' to be a nurse (Barriball & While, 1996: Dockerv & Barns, 2005: Prater & McEwen, 2006).
In a comparison of the career motivations of nursing students and students of other disciplines, Dockery and Barns (2005) found that nursing students were more strongly motivated by extrinsic rewards, such as flexible hours, autonomy, employment security, and travel opportunities. A commonality among all the studies reported above was that they were conducted with traditional-aged, undergraduate students entering the study of nursing as their initial, post-high-school educational experience and as the pathway to their first career.
Only two studies have explored the motivations and interests of non-traditional undergraduate students. Bye, Pushkar, and Conway (2007) examined the differences in motivation between students 21 years of age or younger and students 28 years of age or older; they found that the older students reported higher levels of intrinsic motivation for choosing a career. Many of the older students were able to outline their deliberate decision process to enter the study of nursing later in life. Similar generational differences in career choice motivators have also been reported by Miers, Rickaby, and Pollard (2007). Knowles (1984) observed that adult students approach learning in the context of life application. Thus understanding the motives of the second degree/career changing student is important to the development of high quality programs of study and to the recruitment and retention of this growing and valued population of nursing students in the nursing workforce.
The purpose of this research study was to explore the self-described factors motivating individuals to seek the opportunity to study nursing in an accelerated, second-degree, nursing program. The research question guiding Methodtnis study was: What are the factors leading to a decision to study nursing? This descriptive study utilized an inductive content analysis process to analyze pre-existing written documents.
My primary interest in this study was to identify the participants' subjective descriptions of the factors that lead them to pursue a career in nursing. The data for this analysis came from the admission essays submitted by applicants to the program. One component of the program admission process asked individuals to write a story describing the factors that influenced their decision to pursue the study of nursing as a second career. Using comprehensive sampling, the written essays of all individuals admitted to the first two cohorts (n=66) of the accelerated, second degree program at a university in the southeastern U S were analyzed. The study proposal was approved by the University Institutional Review Board (IRB) for a retrospective analysis of existing documents to occur after all students in the designated cohorts had completed their program of study.
The analysis process was initiated by reading each essay and organizing the data into a table. The table began as a series of columns labeled with a code name assigned to each essay and two rows, with one row titled 'what attracts you to nursing' and the other row titled 'what will you bring to nursing.' These row heading were consistent with the essay prompts given to the applicant. Each row was expandable to account for multiple entries from each essay. During the initial reading of each essay, data was added to the table. As the analysis process continued the data were matched and categorized across the columns to identify commonalities and groupings within these two broad labels.
During this analysis process common factors that led these prospective students to their decision to study nursing were identified. Content analysis with an inductive approach was used in this analysis. The written stories were analyzed for the presence of words, statements, and paragraphs that were then extracted to identify the factors leading to the decision by these individuals to change their career and to study nursing. As factors were identified, frequency counts were compiled. To further illustrate the meaning of each factor, specific quotes that provided a rich description of the meanings were also extracted from the data. The final step of the analysis involved the grouping of main categories and subcategories, and the emergence of themes. In some cases students identified more than one main category that contributed to a specific theme.
I kept extensive notes during the analysis process to create an audit trail and to control for bias. At the conclusion of the analysis, two independent reviewers reviewed the data and confirmed the reproducibility of categories and subcategories. They confirmed that the extracted quotations were valid illustrations of the meaning.
Sixty-six stories, written by members of the first two cohorts of students while they were still prospective students, were analyzed. A majority of participants (n=54, 81%) held a baccalaureate degree in non-healthrelated fields of study. Demographic characteristics of the group are presented in Table 1. Since this was a retrospective analysis, it was known that all 66 of the students successfully completed the program of study, passed the NCLEX-RN, and obtained a position as a registered nurse within six months following their graduation. The factors leading to a desire to study nursing grouped into three thematic categories, namely 'What I bring to nursing, "Seeking satisfying work' and 'Missing pieces.'
The first theme, 'What I bring to nursing,' included two main categories, specifically work skills and educational background (Table 2). The first category, work skills, focused on specific skills and abilities the students had developed in their current career and their projected use of these skills in nursing. Many of the sub-categories identified, such as critical thinking skills and communication skills, are foundational skills taught in the early or foundational courses in most nursing education programs. The second category, educational background, focused on how the students projected that their previous discipline of study would enhance their study of nursing. These findings provided evidence that one factor leading to the desire to study in an accelerated nursing program was grounded in their reflection on the skills, abilities, and knowledge they could bring to the desired new career.
'Seeking satisfying work' was the second theme and was the most internally focused of the three themes. Feeling satisfied, and seeing what nurses do as satisfying, were the major categories (Table 3). Feeling satisfied focused on the nature of their current work activities and their lack of satisfaction in these activities. This category addressed an internal feeling of the individual. The second category, seeing what nurses do as satisfying, was grounded in observing nurses providing care and seeking their opportunity to develop the skills needed to be a nurse. These observations had occurred during work-related and volunteer opportunities in which they had participated.
The third theme, 'Missing pieces,' emerged from the categories of greater responsibility to help others and desire for more knowledge (Table 4). The first category, responsibility to help others, included both a desire to do more than a task or procedure and a focus on whole persons and responsibility to humanity. This category reflects a desire to do for others, on both the individual and societal level. The second category, desire for more knowledge, was common among individuals with a prior degree and work experience in healthcare and human service professions. These individuals recognized the more holistic and person-focused nature of nursing as compared with their current discipline.
Consistent with existing literature describing motivations of traditional nurses to enter nursing, these students identified caring for others and contributing to the well being of society as a component of their decision to become a nurse (Newton et al., 2009; Zyberg & Berry, 2005). The findings of this study are also consistent with the way the literature describes second degree/career changing students as goal directed in their decisions (AACN, 2008a; Raines fr $ipes, 2008).
However, unlike the literature describing factors motivating traditional undergraduate students to study nursing, no one in this sample mentioned individual or family illness or hospitalization as a factor in their decision to become a nurse. Only one student mentioned having family members in the healthcare field as a motivating factor. In addition, the students in this study were not motivated to become nurses by factors related to the extrinsic rewards of nursing, such as flexible hours, employment security, or travel opportunities. In fact these factors were not even mentioned in the data. This is contrary to the findings of Dockery and Barns (2005) who found traditional students to be motivated by the extrinsic rewards of nursing.
In this sample, the factors influencing the decision to study nursing focused primarily on intrinsically guided motivations, based on self-reflection and the seeking of opportunities to observe and come to know nursing and the work of nurses. This is consistent with Bye et al. 's (2007) finding regarding the influence of age on intrinsic motivation. Given that the respondents in this study had a median age of 36.6 years, the finding of deeper reflection on career choices and intrinsic motivations is consistent with the literature on the career choices after the age of 30 years (Miers et al., 2007).
The findings of this research are, to a large extent, consistent with the generational differences found by Bye et al. (2007) and Miers et al. (2007). The students described their decision to become a nurse within the context of their prior education and identified knowledge, skills, and abilities that would support them in becoming a nurse. They also described how they specifically sought out opportunities to refine and confirm their decision to seek a career in nursing. These findings suggest that second degree students desiring to become nurses are different from the traditional undergraduate students who choose to study nursing. Recognizing these differences and building on the attributes and goals these second degree students bring to the study of nursing is important for both recruiting and retaining these individuals. Recognizing that differing factors motivate this new student population is important to nurse educators as they develop nursing education programs to prepare second degree students to enter the nursing workforce. It is important to nursing administrators as they seek appropriate ways in which to reward these nurses.
The primary limitation of this study is the lack of generalizability. The sample was limited to applicants at one university-based program. Also there is no comparison group of students who applied but were not admitted to the program of study. Additionally these essays were written by prospective students seeking admission to this nursing program. It is possible that social desirability influenced some of these responses.
The students in this study described what attracted them to the study of nursing and what they believed they brought to the study and practice of nursing. In designing programs of study for this population of students, educators need to acknowledge both what these students hope to gain from nursing and the unique strengths they bring to the study and practice of nursing. Traditionally, undergraduate nursing education programs have been grounded in a behaviorist approach to learning (Raines, 2006). This approach has been predicated on the teaching activities of the instructor and on the student coming to know the various objective entities, attributes, and relationships as defined by the faculty, separate from personal experiences (Ormrod, 1999; Peters, 2005). Traditional didactic content and structured clinical courses have characterized traditional undergraduate education.
However, the second degree student has knowledge, experiences, skills, and attributes to share with others. Recognizing and valuing the experiences, knowledge, skills, and abilities these students bring to their studies facilitates the use of new patterns of learning and socialization into the profession. The use of learning communities in which learners share their strengths and collaboratively explore and learn specific content has been shown to be ideal for this population of learners (Ironside, 2005; Raines, 2006: Voorhees, 2001). These communities can help prepare students for continued learning in practice settings. While the generalist nature of the undergraduate program of study needs to be maintained, recognition of the specific goals and motivations of second degree learners also needs to be acknowledged. Recognizing the existence of these already developed skills and their transferability to the practice of nursing provides an opportunity to truly accelerate the course of study. The design of an accelerated second degree program of study is not just a faster version of the traditional program of study, but rather a unique program of study that recognizes and values the previous education, experience, knowledge, and abilities the second degree students bring with them.
Research is needed to validate more specifically what knowledge and skills in critical thinking, problem solving, interpersonal relationships, and communication these students bring to their program study. The use of competency validation testing, self-paced learning modules, and portfolio review are some strategies that can be used to validate the skills and behaviors these students bring to the study of nursing.
It is important for leaders in the nursing workforce to listen to the factors that attracted these individuals to the study of nursing and to recognize the positive impact the goals of these second degree students may have on the workforce issues facing the profession of nursing. As these nurses enter the workforce, employers need to both acknowledge what these graduates bring to nursing and also provide a work environment that gives these nurses a sense of satisfaction and the opportunity to add the 'missing pieces' these students described in their essays. The long-standing, traditional incentives often used to recruit and retain graduate nurses, such as scholarship support with a promised two-years employment commitment based on employer need, employer sponsored NCLEX-prep courses, and sign-on bonuses to work in general medical-surgical units, may not be attractive or effective with this group of graduate nurses. As described above, the literature supports that the second degree nursing graduate is a valued commodity in the nursing workforce. The findings of this study contribute to the evidence base for the need to initiate specific recruitment and retention programs that will keep these nurses in the professional workforce and involved in the care of persons in need of a nurse.
Accelerated second degree programs of study were initiated to prepare additional nurses to meet the demand for an adequate number of nurses in the nursing workforce. To recruit this population of students into nursing education programs and to retain these graduates in the nursing workforce, it is critical to listen to their career goals and aspirations. Educational programs and workplace environments need to be redesigned to recognize the unique strengths this population of nurses can bring to the practice of nursing. These nurses desire to make a difference in the workforce. Nursing educators and administrators need to provide an environment in which they can do so.
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Deborah A. Raines, PhD, RN, ANEF
Deborah A. Raines, PhD, RN, ANEF
Dr. Raines is the Director of Scholarship for the Florida Atlantic University in Boca Raton, FL, and a Professor in the College of Nursing. She was the founding director of the accelerated second degree BSN program at the Christine E. Lynn College of Nursing at Florida Atlantic University. The initial program development and first two cohorts of students were supported by an educational grant from Tenet Healthcare Foundation. Dr. Raines has also published articles on the innovative, immersion-learning model, CAN-Care, designed specifically for the clinical practice education of the second degree student. She received her BSN from Syracuse University (NY), her MSN from the University of Pennsylvania in Philadelphia (PA), and her PhD from Virginia Commonwealth University in Richmond, VA.