Nursing careers: what motivated nurses to choose their profession?

Abstract

This paper considers self-reported reasons for choosing to be a nurse and intentions related to remaining in the profession, The data are drawn from a survey of Western Australian Registered Nurses which was part of a broader study of issues for recruitment and retention of nurses in the context of current labour market opportunities for women. The paper finds that what we have termed the 'intrinsic attraction' of nursing has been a key element in the decision to enter nursing for the bulk of nurses, while 'employment security 'aspects of the job are also a focus. Interestingly, only a minority of nurses rated the 'extrinsic rewards' highly as a factor in decision making. The paper notes that there are some areas of significant difference in nursing career selection motivation between older and younger nurses; this finding does have policy implications for both health authorities and employers.

Introduction

In the last decades of the twentieth century the female workforce participation rate, especially that of married women, continued to grow (ABS 2001) and women moved in increasing numbers into professional and para-professional occupations (ABS 2001). Traditional feminised occupations such as nursing and teaching have increasingly been in the media in relation to recruitment and retention problems (The Australian 2005a.) Politicians, aware of the electoral sensitivity of health, have campaigned on policy platforms which promise to reduce the 'shortage'. Their proposals have included promises to improve pay (The Australian 2005b.), fund many new student places (Nelson 2004), quarantine nursing places from the Higher Education Contribution Scheme (HECS) fee increases, and target immigration to recruit skilled nurses from overseas.

Such simplistic solutions, however, overlook the complexities underpinning the apparent 'shortage' (Nowak 2000). These include the labour supply/hours of work decisions of those with nursing qualifications who are either not currently working in nursing or do so part-time. The term shortage also carries with it '... the presumption that "reasonable" recruitment efforts have been made, and "reasonable" wages and training prospects offered ...' (Green, Machin and Wilkinson 1998: p.167) Apparently simple solutions such as preferential university places and immigration have their own costs and, without attention to workplace and marketplace realities, may not provide long-term solutions.

While the focus of many of the government-initiated responses is on increasing the supply of people with nursing qualifications, the set of factors which contribute to the renewal of the workforce via new entrants to the profession is complex. Dockery and Barns (herein) explore the elements of the decision to be a nurse with particular emphasis on those who have just made or are in the process of making that decision.

Long lead times in the development of experienced professionals and the requirement to make provision for the training of professionals mean that we cannot rely on market signals to provide an immediate response in terms of supply. Thus it is also important to understand the motivating factors and intentions of existing nursing qualified workers to assist in targeting retention strategies and to encourage those working part-time to expand their hours of work. It is interesting to note in this latter regard that Shanahan (1993), in discussing rising nurse incomes, proposes that in the United States the overall supply curve of nurses is backward bending.

One overall focus of the research program within which this work was undertaken was on whether the increasing career options open to young women (Boughn 2001) in the 21st century compared with 20 to 30 years ago have brought about significant changes in market supply conditions in nursing.

In this paper we seek to expand our understanding of one aspect of the motivation of the current registered nurse (RN) workforce through an examination of self-reported reasons for entering the profession and intentions relating to remaining in the profession. The paper argues that an understanding of the motivation of those choosing nursing is important input for managers seeking to recruit and retain nurses in their workplace.

Following a brief discussion of the job matching literature, we then look at the motivating factors for choosing nursing from the survey respondents. We report the results using six components or themes identified using factor analysis. We explore inter-generational differences in motivation using the device of cohort analysis and two cohorts representative of the changing career opportunities for women. Finally, data on decisions to leave nursing are compared with those identified as continuing in nursing and those who would choose nursing again compared with those who would not. The implications for recruitment to and retention in the health system are discussed.

Background

The literature on job shopping/employment matching gives some insight into the relationship between prior beliefs about jobs, experience of those jobs and employment mobility. Miller (1984) was the first to depart from the assumption in these models that worker' prior beliefs about the utility of all jobs were homogeneous. Miller assumed that prior beliefs about jobs differ and that workers then sample information about job characteristics on-the-job. This sampling serves to allow the worker to forecast better future returns, including non-pecuniary returns. The model was used by Miller to explain mobility of workers.

Price and Mueller argued that intention to leave an occupational field is an emotional response toward work or the profession (Price and Mueller 1981). Leong, Huang and Hsu (2003) found that 'job involvement', which measures active participation, psychological and values identification with the job being performed, is positively related to commitment to the profession. Intention to leave the profession of nursing was found by Krausz, Koslowsky, Shalom and Elyakim (1995) to be the cumulative effect of intention to leave the ward or the hospital. Their additive model suggests nurses most prone to leave the hospital of employment perceive their work as offering little challenge, autonomy or opportunity to express their abilities and skills, with high burnout. They propose that intention to leave the hospital is a sequential step in the decision to leave the profession.

It is important to consider initial expectations of the match between personal motivating factors in the choice of a profession and the experience of that match by nursing professionals. In this study, that is reflected in variables such as intention to remain in nursing and whether nurses would make the same decision, if given the decision to make again. Current initiatives to address perceived supply problems at both the Commonwealth level and by state health authorities include increasing student numbers in nursing courses. The literature on job matching suggests that, in part, the potential impact on supply of these initiatives will depend on the match between the motives for the choice of profession by prospective nurses and their subsequent experience of nursing positions. Mismatches are expected to result in increased turnover and wastage from among the new graduates. As a guide to expectations, it will be useful to understand the reported motivation for undertaking nursing training as reported by those currently registered as professional nurses.

The 2002 WARN Survey

The 2002 RN Survey was a comprehensive instrument covering a range of issues relating to becoming a nurse, nursing practice, work and family balance, and intention to cease nursing. The survey instrument is discussed in detail by Nowak (herein). For this paper, we focus primarily on the factors which influenced respondents when choosing nursing as their career, (2) whether participants intend to remain in nursing and whether, if they could go back in time, they would choose nursing again. The data all relate to nurses who were registered with the Nurses Registration Board in Western Australia in 2002. The question on the decision to become a nurse included 28 statements about career decision motivations drawn from the literature on career choice, nursing literature and discussion during the pilot study. Responses were on a 5 point scale from 1, 'no importance', to 5, 'very important'.

The data enable us to consider the most important contributing factors for survey respondents in the initial decision to enter nursing. We use factor analysis to identify the dominant themes. The data enable us to compare the responses of those we term 'lost to nursing' with those of the respondents who say that they will remain in nursing. The respondents were asked a question relating to whether they would still choose to be a nurse with hindsight. The important career choice factors for those who would are analysed relative to those who say they would not.

The findings presented also include disaggregated data to enable an intergenerational comparison of the newest entry cohort of nurses (up to and including 30 years) and the cohort who made decisions to train for nursing between 25 and 35 years ago (those 40 to 50 years of age). We recognise that differences in responses between the age groups, while providing an intergenerational view of the decision to become a nurse, might also reflect differences in the nature of respondents' education and their experiences in nursing. The vast majority of those in the 40 to 50 years cohort (and those above 50 years) would almost certainly have undertaken hospital based training for the profession, while those 30 and under would have all undertaken university based initial training (3).

In our disaggregation of the data, 40 years of age was chosen as the lower end of the older cohort, as survey data reflect this to be the age at which this marked shift occurred from hospital based training to university education. We used 30 years as the upper age of the younger cohort to reduce the influence of the overlap of hospital based and tertiary education based training and education.

The younger cohort represents 10 per cent of all RN Survey participants, while the older cohort represents 37.3 per cent of the sample; participants in the age categories of 31 to 39 years were 25.4 per cent of the sample and over 50 years 27.3 per cent. As a point of reference, we note that the age profile of nurses in Australia is significantly skewed, with the majority being over 40 years of age (Shah and Burke 2001).

Initial Career Expectations

Myer, Allen and Smith (1993) note that personal characteristics and work experiences are included in the antecedents of commitment, particularly affective commitment. They note that:

   Employees whose experiences with organisations are consistent
   with their expectations and satisfy their basic needs tend to
   develop a stronger affective attachment to the organisation than
   do those whose experiences are less satisfying. (Meyer et al, p.539)

Meyer et al. go on to say that factors associated with affective attachment are equally applicable to occupation.

In the 2002 RN Survey respondents were asked to indicate the extent to which each of 28 statements was a consideration in their initial decision to become a nurse. We are aware that participants in the survey represent differing lengths of experience and varying ages and that their responses to these statements are based on their recollections of themselves at that earlier time in their lives. Hopper and van der Kolk (2001) studied extensively the limitations of memory recall questions when searching retrieval of traumatic memories. Many of their findings covered general memory retrieval questions and could be applied to any memory recall survey methodology. They indicate that the major limitation of recall oriented studies concerns the environment created for retrieval of memories. In general terms, memory triggered by survey questions, or cued memory, may not be the same as memories recalled under other circumstances. In addition, they noted that police studies have found that 'directing' a subject's recall can produce different memories of events compared with what actually happened. Further, memory characteristics can change over time, depending on the individual's cumulative experiences. This latter issue is particularly pertinent to the responses to this set of questions around choice of nursing, since the respondents have subsequently had experience of the profession.

Nevertheless our confidence that these responses reasonably reflect those decisions at the time is boosted by their consistency with our 2003 Student Survey data, which investigates the occupational choice of first year university students (Nowak, Preston, Dockery and McCabe 2003). This survey, which over-sampled nursing students, provided 20 statements/factors to students and asked them to rate how important each factor was in what they were looking for in an occupation. Nineteen of the statements provided were either identical or very similar to the statements used in the 2002 RN Survey. Table 1 compares those replicated statements, using a mean score, to demonstrate that there is reasonable consistency in responses between people who had just made their decisions to enter nursing and the recollections of qualified nurses relating to the factors they considered when choosing to enter nursing.

Notably, student nurses and qualified nurses from the two studies both rated the same three factors most highly: working to help others; interesting (and challenging) work; and working closely with people. Dockery and Barns (herein) present findings which draw on the above mentioned survey of occupational choice, comparing nursing students with male students and other female (non-nursing) students. With the exception of 'Interesting work', Dockery and Barns found a significant difference between nursing students and both male students and female non-nursing students in relation to the factors rated highly in the decision to choose an occupation.

Motivating Factors for Choosing Nursing

To explore the grouping of responses by all respondents, a factor analysis was undertaken. Using the SPSS program, we ran a Principal Component Analysis. Six components with Eigen values greater than one were identified. All 28 variables loaded with a correlation coefficient greater than 0.3. The Kaiser-Meyer-Olkin Measure of Sampling Adequacy value was .897 and Bartlett's Test of Sphericity was significant (p=.000). (See Appendix 1 for the table presenting the components identified and associated loadings.)

The six factors which appeared to reflect the common themes in how the statements loaded onto the components were identified as:

* Extrinsic rewards of nursing

* Employment security over life of nursing

* Immediacy of support on entry to nursing

* Influence of others in choosing nursing

* Travel opportunities of nursing

Of the six factors, 'intrinsic attraction of nursing' explained 29.4 per cent of variance; the remaining factors accounted for 32.5 per cent of variance, with 'extrinsic rewards' accounting for 9.4 per cent and 'employment security' 8.2 per cent, 'support on entry' 5.7 per cent, 'influence of others' 5.5 per cent and 'travel opportunities' (a single statement) 3.7 per cent. Table 2 sorts the 28 statements from the questionnaire under the six components. It also reports the strength of support for the individual statements in terms of frequency, focusing on both ends of the scale, 'no importance/minor importance', and 'important/very important'. The remaining responses which fell into the mid-range 'some importance' category have been excluded from this table.

From this table we can see that predominantly the statements falling into the component we have named 'intrinsic attraction of nursing' are also those rated most highly as 'important/very important'. 'Interesting and challenging work' and 'ability to help others', both loading on the intrinsic factor, were reported as 'important/very important' influences on their choice of profession by over 80 per cent of all respondents. Four other responses rate over 70 per cent 'important/ very important': with the exception of 'job security' these items all loaded on the factor we have identified as the 'intrinsic attractions of nursing'.

Issues around employment security/flexibility were also rated quite highly by nurses. Within this category there was strong support for statements relating to 'job security', 'skills in demand' and 'ability to leave and return'.

It is also interesting to note that within the component that we have labelled 'extrinsic rewards', starting salary was 'important/very important' to only 24 per cent of the total respondents, while future earnings potential was reported as 'important/very important' for only 36 per cent of the respondents and 'opportunities for advancement' by 34.8 per cent. 'Flexible hours' and 'responsibility and autonomy', rated by 46 per cent and 41 per cent respectively as 'important/very important', were the individual statements with strongest positive support within the 'extrinsic rewards' component. The items in the component 'support on entry to nursing' reflect the conditions applying for hospital based training which no longer apply. Nevertheless it is important to note that this support was perceived to be of importance in the decision to enter nursing at that time when such support was a component of the hospital based training system.

Intergenerational Differences in Career Choice Motivation

When we look for inter-generational similarities and differences through a disaggregation of the data, we can see marked similarities between the statements most frequently reported as being 'important/very important'. But we also start to see variations in motivating factors. Table 3 presents the responses of the younger and older cohorts we selected to study, with a comparative figure for each statement reflecting attribution of very important/important by all participants in the survey. The statements are grouped against the six components identified through our earlier factor analysis.

From Table 3 we see that the younger cohort placed significantly more emphasis on such intrinsic work factors as mentally challenging and exciting work. By contrast, this cohort placed less prominence on prestige of the profession and community respect for the profession, also considered intrinsic factors of nursing.

As remarked earlier for the total sample, substantially less than 50 per cent of both younger and older cohorts reported starting salary as important/very important (25 per cent and 27 per cent respectively); this observation is also true for future earnings potential (40 per cent and 38 per cent respectively). The younger cohort did, however, place greater emphasis than older nurses on a number of extrinsic rewards which they anticipated within the profession, including responsibility and autonomy, pleasant working conditions, opportunities for creativity and originality, and flexibility of hours. These, however, still rated important/very important for less than 50 per cent of the cohort.

Although time required to qualify for the profession was not an issue rated particularly highly by either the younger or older cohort (18 per cent and 27 per cent respectively), there was a significant difference between the two cohorts in relation to it. The older cohort placed greater emphasis on this issue in considering nursing as an occupation. There may be a link between this and the opportunities for independence noted below.

Importantly, 56 per cent of the older cohort report that their decision to become a nurse was influenced by the consideration that nursing was perceived as a good career for women compared to 24 per cent of the younger cohort. This confirms what we expected in relation to the influence of increasingly wide career options for younger women and less emphasis on stereo-typical roles in their career decisions. Considering the increased options available to young women, we think it interesting to note that the younger cohort placed greater value than did the older cohort on the expected ability that nursing would allow to combine work and family commitments. This may reflect the current work/life balance issues for the two age cohorts. On the other hand, it may be that the older cohort had such limited choice that balancing work and family was not a particular issue in their choice of occupation, whereas many of the options now available to younger women as a career are, or are perceived by this group of nurses to be, less conducive to combining successfully work and family commitments.

The statements relating to immediacy of support on entry to nursing all reflect a significant difference between the older and younger cohorts. The statements associated with this factor suggest that part of the attraction of nursing may have been the ability to live relatively independent of family or other support. The much greater importance attributed to this factor by the older cohort than by the younger is likely to reflect the fact that these support mechanisms were removed when nursing education changed to a university qualification. As indicated earlier, the majority of the older cohort would be a product of the earlier hospital based training and may well have utilised those support mechanisms.

Reasons for Choosing Nursing and the Decision to Leave

As indicated in reviewing the literature, a mismatch between expectations of a professional role and career and the reality experienced by those in that role and career may have implications for retention in the profession. The 2002 RN Survey included a number of questions to identify participants who, although still registered with the WA Nurses Registration Board, no longer actually practised nursing, or who anticipated ceasing to practice within five years of the survey or, if they were currently not working at all, did not plan to return to nursing within five years. Table 4 presents the factors associated with the decision to enter nursing by those survey participants who did not plan to cease nursing within five years ('still nursing') and those who had either already ceased to practise or planned to do so within five years ('lost to nursing'). In order to avoid undue influence on the findings caused by normal or early retirement, the table excludes responses from those aged over 50 years and the 25 participants who did not indicate their age.

As can be seen, there are seven factors returning a significant difference, between RNs who are effectively lost to nursing and those who plan to continue nursing, in their level of importance in the decision to choose nursing. In only one instance is there greater emphasis on a factor's importance associated with those who are lost to nursing: that factor is ability to make a strong contribution to society. To judge from the reasons for entering the profession and the decision to cease practising, there is little to indicate that those who are considered lost to nursing had any greater expectations of their profession than their counterparts remaining.

An analysis of the frequency distributions identified that those aged under 35 years were significantly more likely to be 'lost to nursing' than those in the age group 35-50 years. One possible explanation for this is that the data for the younger group is capturing the impact of job matching decisions in relation to occupational choice (Miller 1984), while for the older cohorts these decisions have been made and those who found that the rewards did not meet expectations have already left the profession. A second related explanation is that older nurses have less time to realise returns to investments in alternative occupations while they do have important investment in the nursing profession.

Impact of Experience on the Decision to Choose Nursing

Using the data from the 2002 RN Survey, we are able to consider how survey participants, with the benefit of their experience, would now look at the decision to enter nursing should they have the opportunity to make that choice again. Participants were asked: 'If you could go back in time, would you still choose nursing?' Using responses from only those participants intending to continue in nursing, we present in Table 5 the motivating factors in deciding to become a nurse broken down into the 'yes' or 'no' response options permitted by the question.

The level of importance placed on the motivating factors differs significantly between those who would choose nursing again and those who would not on sixteen statements. Using frequency of responses to indicate emphasis, we can see that those who would not take up nursing again placed greater emphasis on four motivating factors (percentage of respondents attributing a very important/ important rating is shown in brackets): pleasant working conditions (37.3 per cent versus 34.6 per cent), the profession being perceived to carry prestige (29 per cent versus 28.3 per cent), opportunities for creativity and originality (26.4 per cent versus 24.2 per cent) and career adviser's/teacher's advice (9.6 per cent versus 5.2 per cent). Applying the components generated by factor analysis as a reference point, we find no clear grouping of the factors which have greater significance to those who would not choose nursing again.

The remaining 12 statements reflecting a significant difference between the two groups suggest that those who would choose nursing again placed a substantially higher level of importance on factors intrinsic to nursing (component 1). For component 2 (extrinsic rewards of nursing), the frequencies differed substantially in relation only to flexible hours of work. Interestingly, of the five factors comprising component 3 (employment security over life of nursing), four reflected a significant difference between the two groups; in every instance those who would choose nursing again reported a substantially higher frequency of very important/important than those who would not.

These nurses have all indicated that they have no intention to cease practising nursing within five years of the survey. But 36.5 per cent clearly stated that if they had the decision to make over again, they would not choose nursing. A key question which remains largely unanswered here is what keeps these people in nursing. These existing nurses do have an investment in a nursing qualification. We have also noted earlier that the younger nurses were significantly more likely to be 'lost to nursing'. One possible explanation is that the older nurses are 'rusted-on'; they do not have sufficient incentive and opportunity now to undertake new occupational training and obtain the rewards. We may need to be concerned, however, that almost 40 per cent of respondents who expect to remain in nursing would not have chosen to nurse had they been making the decision with hindsight. Such disaffection is an important issue.

Conclusion

The data of the 2002 WARN Survey suggest that the nursing profession has three current key initial areas of appeal for those choosing to train for the profession: (1) the factors perceived to be intrinsic attractions of nursing such as interesting and challenging work, the ability to help others and the ability to work closely with people; (2) aspects pertaining to employment security, whereby work can be obtained when wanted or needed, and the facility to combine work and family commitments; and (3) the travel opportunities available to those with a nursing qualification. Reinforcing the importance of intrinsic attraction of nursing and those elements which have been labelled 'employability' is the fact that when responses are compared between those who would and would not choose nursing again, there is a substantially higher value placed on these factors by those who would choose nursing again. This suggests that for those strongly motivated by such factors, the nursing profession may be providing returns in line with their expectations.

We have excluded from the above 'support on entry to nursing,' because the conditions involved related to those available for hospital based training. It remains, however, a consideration in relation to those aspects of choosing to be a nurse which may be subject to policy change. In particular, while it is clear that nursing qualifications will remain in the tertiary education sector, support for training can be increased.

It is also important to note that there appear to be significant differences in the elements of attraction to nursing between younger and older nurses. In particular, younger nurses have placed greater value than have their older colleagues on mentally challenging and exciting work. In addition, while extrinsic rewards were not frequently reported by either the younger or older cohort, there was a significant difference between the two on several of the extrinsic factors. Notably, the younger cohort had greater concern for flexible hours of work, responsibility and autonomy, pleasant working conditions and opportunities for creativity and originality. All of these factors have implications for management in their consideration of the work environment and the structure of work which they support.

Appendix 1

Statements reflecting an intrinsic attraction of nursing (component 1) explain 29.42 per cent of the variance. Components 2 (extrinsic rewards of nursing) and 3 (employment security over life of nursing) explain 9.4 per cent and 8.17 per cent respectively of the total variance. Individual statements were grouped into one factor only, that which reported the highest loading for that statement.

Table A1: Motivating Reasons in the Decision to Enter
Nursing--Varimax Rotated Component Matrix.

                                                     Component

                                                 1        2       3

1. Intrinsic Attraction of Nursing
Ability to make a strong contribution to         .815
  society
Ability to help others                           .789
Ability to work closely with people              .786
Mentally challenging work                        .635
Interesting and challenging work                 .570
Exciting work                                    .566
Community respect for nurses                     .515            .397
The profession was perceived to carry            .488
  prestige

2. Extrinsic rewards of nursing
Future earnings potential                                .792
Starting salary                                          .760
Opportunities for promotion/advancement                  .641
Pleasant working conditions                              .620
Opportunities for creativity and originality     .408    .571
Flexible hours of work                                   .548    .425
Responsibility and autonomy in profession        .477    .506
Time required to qualify for profession                  .491

3. Employment security over life of nursing
Ability to leave the job and return later                        .781
Nursing skills always seemed in demand                           .762
Job security                                             .322    .607
Ability to combine work and family                       .484    .559
  commitments
Nursing was a good career for women                              .527

4. Immediacy of support on entry to nursing
Training was provided on the job
Ability to earn while studying
Accommodation was provided while training

5. Influence of others in choosing nursing
Career adviser's/teacher's advice
Parental advice
Ability to be with my friends who had chosen
  nursing

6. Travel opportunities of nursing
Opportunities for travel                                         .346
% of variance explained                        29.42    9.4     8.17

                                                     Component

                                                 4        5       6

1. Intrinsic Attraction of Nursing
Ability to make a strong contribution to
  society
Ability to help others
Ability to work closely with people
Mentally challenging work                                        .301
Interesting and challenging work                                 .327
Exciting work                                                    .499
Community respect for nurses
The profession was perceived to carry                    .406
  prestige

2. Extrinsic rewards of nursing
Future earnings potential
Starting salary
Opportunities for promotion/advancement
Pleasant working conditions
Opportunities for creativity and originality                     .343
Flexible hours of work
Responsibility and autonomy in profession
Time required to qualify for profession          .303    .329

3. Employment security over life of nursing
Ability to leave the job and return later
Nursing skills always seemed in demand
Job security
Ability to combine work and family
  commitments
Nursing was a good career for women                      .347

4. Immediacy of support on entry to nursing
Training was provided on the job                 .889
Ability to earn while studying                   .866
Accommodation was provided while training        .779

5. Influence of others in choosing nursing
Career adviser's/teacher's advice                        .759
Parental advice                                          .686
Ability to be with my friends who had chosen             .634
  nursing

6. Travel opportunities of nursing
Opportunities for travel                                         .631
% of variance explained                         5.72    5.48    3.67

Extraction Method: Principal Component Analysis. Rotation Method:
Varimax with Kaiser Normalization.

References

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Nowak, M., Preston, A., Dockery, M. and McCabe, R. (2003), Study of Occupational Choice: 2003 Survey of 1st Year University Students in Western Australia, [Computer File], WEPAU, Curtin University of Technology, Perth. from. http:// www.cbs.curtin.edu.au/research/wepau

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Endnotes

(1) Research for this paper was financed, in part, by an ARC SPIRT Grant (C 100107735) which the authors gratefully acknowledge.

(2) Participation in the survey required only that the recipient be currently registered as a nurse. Accordingly the survey was designed to allow meaningful answers by participants regardless of whether or not they were in paid work or whether they were practising as a nurse.

(3) Transferring registered nurse education to higher education sector was announced by Commonwealth ministers in 1984. The move to the higher education sector was begun by the State Grant Act of 1985 and was to be completed by 1993. (Francis and Humphreys, 1999). In WA the West Australian School of Nursing was the last to close--December 1994--mental health nursing. That would have meant the last intake was 1992. as it was a three year program.

Rebecca McCabe, Margaret Nowak and Scott Mullen *

* Graduate School of Business, Curtin University of Technology

Table 1: Comparison of factors Student Nurses
with Factors RNs considered when choosing Nursing.

                                         Student
Student Nurses:                           Nurses
Looked for in an                         (n=160)
occupation (a.)                            Mean

Working to help others                     4.6

Interesting work                           4.6

Working closely with people                4.4

Job security                               4.3

Challenging work                           4.2

Ability to leave the workforce and         4.3
return later to that occupation

Ability to make a strong contribution      4.1
to society

Opportunities for travel                   3.9

Exciting work                              4.0

Community respect for your occupation      3.9

Potential to combine work and              4.2
family commitments

Flexible hours of work                     4.0

Future earnings potential                  3.7

Opportunities for promotion /              3.6
advancement

Responsibility in job                      4.1

Pleasant working conditions                3.6

Professional prestige / high status        2.6

Graduate starting salary                   3.1

Opportunities for creativity and           2.8
originality

RNs:
Considered when                            RNs
choosing                                 (n-1846)
Nursing (b.)                               Mean

Ability to help others                     4.3

Interesting and challenging work           4.2

Ability to work closely with people        4.0

Job security                               3.9

Mentally challenging work                  3.8

Ability to leave the job and return        3.6
later

Ability to make a strong contribution      3.6
to society

Opportunities for travel                   3.6

Exciting work                              3.4

Community respect for nurses               3.2

Ability to combine work and family         3.2
commitments

Flexible hours of work                     3.2

Future earnings potential                  3.0

Opportunities for promotion/               3.0
advancement

Responsibility and autonomy in
profession                                 3.0

Pleasant working conditions                2.9

The profession was perceived to            2.7
carry prestige

Starting salary                            2.6

Opportunities for creativity and           2.6
originality

(a.) Q20 Nowak et al 2003 'What are you looking for in an occupation?
Please indicate the importance, if any, you attach to each of the
following job characteristics.' (1= No Importance at all, 2= Minor,
3=some, 4=Important, 5=Very Important)

(b.) Q6 Nowak et al 2002 'When choosing nursing as your career,
how important, if at all, were the following:'
(1= No Importance at all, 2= Minor, 3=some,
4=Important, 5=Very Important)

Table 2: Motivating reasons in the decision to enter nursing: percentage
of all respondents.

                                                             Important/
                                                No/Minor        Very
                                               Importance       Impt.

1. Intrinsic Attraction of Nursing
Ability to make a strong
  contribution to society                         17.9          60.0
Ability to help others                             4.5          85.3
Ability to work closely with people                8.1          77.3
Mentally challenging work                          9.0          70.5
Interesting and challenging work                   3.7          85.5
Exciting work                                     17.3          54.6
Community respect for nurses                      26.8          45.8
The profession was
  perceived to carry prestige                     43.4          28.4

2. Extrinsic rewards of nursing
Future earnings potential                         34.0          36.3
Starting salary                                   49.6          23.8
Opportunities for promotion/advancement           33.7          34.8
Pleasant working conditions                       36.6          34.6
Opportunities for creativity
  and originality                                 46.2          25.2
Flexible hours of work                            30.2          46.1
Responsibility and autonomy in profession         30.9          41.0
Time required to qualify for profession           53.5          25.6

3. Employment security over life of nursing
Ability to leave the job and return later         19.9          64.1
Nursing skills always seemed in demand            14.1          70.7
Job security                                      10.0          75.0
Ability to combine work and
   family commitments                             33.6          50.1
Nursing was a good career for women               30.9          50.7

4. Immediacy of support on entry to nursing
Training was provided on the job                  20.1          68.4
Ability to earn while studying                    23.3          63.3
Accommodation was provided while training         41.1          47.1

5. Influence of others in choosing nursing
Career adviser's/teacher's advice                 82.7           7.7
Parental advice                                   64.7          17.7
Ability to be with my friends
  who had chosen nursing                          71.0          16.2

6. Travel opportunities of nursing
Opportunities for travel                          20.3          60.6

Q6: "When choosing nursing as your career,
how important, if at all, were the following:"

Table 3: Selected Age Cohorts: Motivating reasons in the decision
to enter nursing--percentage of respondents in the category.

(Sorted in descending order by frequency of responding
Very Important/Important.) (% are rounded)

                                                 All
                                             Respondents
                                             Important /
Statements grouped by Component              Very Impt.

1: Intrinsic attraction of nursing                %
Ability to help others                          85.3
Interesting and challenging work                85.5
Ability to work closely with people             77.3
Mentally challenging work **                    70.5
Exciting work **                                54.6
Ability to make a strong contribution           60.0
  to society
Community respect for nurses **                 45.8
The profession was perceived to carry           28.4
  prestige **

2: Extrinsic rewards of nursing
Flexible hours of work **                       46.1
Responsibility and autonomy in                  41.0
  profession **
Future earnings potential                       36.3
Opportunities for promotion/advancement         34.8
Pleasant working conditions **                  34.6
Opportunities for creativity and                25.2
  originality **
Starting salary                                 23.8
Time required to qualify for profession **      25.6

3: Employment security over life of
  nursing
Job security                                    75.0
Nursing skills always seemed in demand          70.7
Ability to leave the job and return later       64.1
Ability to combine work and family              50.1
  commitments **
Nursing was a good career for women **          50.7

4: Immediacy of support on entry to
  nursing
Training was provided on the job **             68.4
Ability to earn while studying **               63.3
Accommodation was provided while                47.1
  training **

5: Influence of others in choosing nursing
Parental advice                                 17.7
Ability to be with my friends who had           16.2
  chosen nursing
Career adviser's/teacher's advice                7.7

6: Travel opportunities of nursing
Opportunities for travel **                     60.6

                                                    30 & under

                                             No / Minor     Important
Statements grouped by Component              Importance    /Very Impt.

1: Intrinsic attraction of nursing                %             %
Ability to help others                            3            91
Interesting and challenging work                  2            91
Ability to work closely with people               7            79
Mentally challenging work **                      4            79
Exciting work **                                 10            65
Ability to make a strong contribution            14            57
  to society
Community respect for nurses **                  33            29
The profession was perceived to carry            51            20
  prestige **

2: Extrinsic rewards of nursing
Flexible hours of work **                        15            47
Responsibility and autonomy in                   19            45
  profession **
Future earnings potential                        29            40
Opportunities for promotion/advancement          26            40
Pleasant working conditions **                   24            39
Opportunities for creativity and                 35            30
  originality **
Starting salary                                  41            25
Time required to qualify for profession **       56            18

3: Employment security over life of
  nursing
Job security                                      8            76
Nursing skills always seemed in demand           13            69
Ability to leave the job and return later        14            69
Ability to combine work and family               22            59
  commitments **
Nursing was a good career for women **           55            24

4: Immediacy of support on entry to
  nursing
Training was provided on the job **              55            26
Ability to earn while studying **                56            24
Accommodation was provided while                 80            10
  training **

5: Influence of others in choosing nursing
Parental advice                                  70            15
Ability to be with my friends who had            80             9
  chosen nursing
Career adviser's/teacher's advice                85             8

6: Travel opportunities of nursing
Opportunities for travel **                      13            70

                                                       40-50

                                             No / Minor    Important /
Statements grouped by Component              Importance    Very Impt.

1: Intrinsic attraction of nursing                %             %
Ability to help others                            4            86
Interesting and challenging work                  4            85
Ability to work closely with people               9            77
Mentally challenging work **                      9            70
Exciting work **                                 20            54
Ability to make a strong contribution            19            59
  to society
Community respect for nurses **                  23            51
The profession was perceived to carry            40            30
  prestige **

2: Extrinsic rewards of nursing
Flexible hours of work **                        35            46
Responsibility and autonomy in                   32            40
  profession **
Future earnings potential                        32            38
Opportunities for promotion/advancement          33            36
Pleasant working conditions **                   37            34
Opportunities for creativity and                 48            25
  originality **
Starting salary                                  47            27
Time required to qualify for profession **       44            27

3: Employment security over life of
  nursing
Job security                                     10            74
Nursing skills always seemed in demand           14            72
Ability to leave the job and return later        19            67
Ability to combine work and family               37            49
  commitments **
Nursing was a good career for women **           25            56

4: Immediacy of support on entry to
  nursing
Training was provided on the job **              11            78
Ability to earn while studying **                14            73
Accommodation was provided while                 34            53
  training **

5: Influence of others in choosing nursing
Parental advice                                  65            17
Ability to be with my friends who had            73            16
  chosen nursing
Career adviser's/teacher's advice                83             7

6: Travel opportunities of nursing
Opportunities for travel **                      22            59

** Statistically significant difference at the .05 level of
significance between the older and younger cohorts.

Table 4: Intentions in relation to continuation to practice nursing
and motivating reasons in the decision to enter nursing--percentage
of respondents in the category.

(Excluding respondents aged over 50 years).

                                                Respondents 50 years
                                                and under (n = 1352)

                                                  Lost to Nursing
                                                     (n = 339)

                                              No / Minor   Important /
                                              Importance   Very Impt.

1: Intrinsic attraction of nursing                %             %
Interesting and challenging work                 4.0          86.2
Ability to help others                           6.3          82.5
Ability to work closely with people              11.1         76.3
Mentally challenging work                        9.5          71.3
Ability to make a strong contribution            21.3         59.5
  to society
Exciting work                                    19.0         54.1
Community respect for nurses                     31.0         40.2
The profession was perceived to carry            49.2         24.5
  prestige

2: Extrinsic rewards of nursing
Responsibility and autonomy in profession        30.4         43.6
Flexible hours of work                           32.9         40.9
Future earnings potential                        29.3         36.9
Pleasant working conditions                      34.9         34.9
Opportunities for promotion/advancement          35.5         33.3
Opportunities for creativity and                 44.0         26.5
  originality
Starting salary                                  45.0         24.5
Time required to qualify for profession          50.2         22.6

3: Employment security over life of nursing
Job security                                     9.1          73.0
Nursing skills always seemed in demand           14.4         68.5
Ability to leave the job and return later        18.9         62.5
Ability to combine work and family               37.3         42.3
  commitments
Nursing was a good career for women              40.7         39.2

4: Immediacy of support on entry to nursing
Training was provided on the job                 27.2         55.7
Ability to earn while studying                   29.8         54.9
Accommodation was provided while training        52.2         34.5

5: Influence of others in choosing nursing
Parental advice                                  68.0         18.3
Ability to be with my friends who had            79.1         12.6
  chosen nursing
Career adviser's/teacher's advice                84.7          8.0

6: Travel opportunities of nursing
Opportunities for travel                         19.1         65.3

                                                Respondents 50 years
                                                and under (n = 1352)

                                                   Still Nursing
                                                     (n = 1013)

                                              No / Minor   Important /
                                              Importance   Very Impt.

1: Intrinsic attraction of nursing                %             %
Interesting and challenging work                 2.9          86.6
Ability to help others                           4.1          85.7
Ability to work closely with people              6.7         78.2 **
Mentally challenging work                        7.6          72.2
Ability to make a strong contribution            17.2        57.1 **
  to society
Exciting work                                    16.1         55.7
Community respect for nurses                     26.3         44.8
The profession was perceived to carry            42.4         26.7
  prestige

2: Extrinsic rewards of nursing
Responsibility and autonomy in profession        30.2         39.5
Flexible hours of work                           26.7        50.1 **
Future earnings potential                        31.4         37.6
Pleasant working conditions                      34.3         34.9
Opportunities for promotion/advancement          32.0         36.2
Opportunities for creativity and                 45.4         24.5
  originality
Starting salary                                  44.2         26.8
Time required to qualify for profession          45.0         25.6

3: Employment security over life of nursing
Job security                                     8.6          76.6
Nursing skills always seemed in demand           13.3         70.8
Ability to leave the job and return later        18.7         66.0
Ability to combine work and family               31.7        52.7 **
  commitments
Nursing was a good career for women              33.2        47.2 **

4: Immediacy of support on entry to nursing
Training was provided on the job                 23.0        66.0 **
Ability to earn while studying                   24.6        63.3 **
Accommodation was provided while training        46.4         42.0

5: Influence of others in choosing nursing
Parental advice                                  65.8         16.3
Ability to be with my friends who had            74.9         13.4
  chosen nursing
Career adviser's/teacher's advice                85.0          6.0

6: Travel opportunities of nursing
Opportunities for travel                         19.3         61.4

** Significant at .05 level

Table 5: Would still choose nursing: respondents not otherwise
considered "Lost to Nursing". Percentage of respondents in each
of the 'yes' category and 'no' category.

                                                If you could go back
                                                 in time, would you
                                               still choose Nursing?
                                                     (n = 1176)

                                                        Yes
                                                 (n = 747 or 63.5%)

                                              No / Minor   Important /
                                              Importance   Very Impt.

1. Intrinsic attraction of nursing                %             %
Interesting and challenging work                 2.6          89.6
Ability to help others                           2.9          89.5
Ability to work closely with people              4.1          81.7
Mentally challenging work                        6.1          76.7
Ability to make a strong contribution            14.1         62.6
  to society
Exciting work                                    11.7         60.1
Community respect for nurses                     25.2         45.6
The profession was perceived to carry            38.7         28.3
  prestige

2. Extrinsic rewards of nursing
Flexible hours of work                           23.6         53.9
Responsibility and autonomy in profession        27.1         43.5
Future earnings potential                        32.1         38.1
Opportunities for promotion/advancement          30.0         36.7
Pleasant working conditions                      32.8         34.6
Time required to qualify for profession          45.7         26.1
Starting salary                                  47.9         24.3
Opportunities for creativity and                 43.6         24.2
  originality

                                                  %             %
3. Employment security over life of nursing       5             5
Job security                                     8.6          80.4
Nursing skills always seemed in demand           13.9         72.6
Ability to leave the job and return later        17.9         68.7
Ability to combine work and family               27.6         57.8
  commitments
Nursing was a good career for women              30.4         52.5

4. Immediacy of support on entry to nursing
Training was provided on the job                 21.0         69.1
Ability to earn while studying                   24.1         63.4
Accommodation was provided while training        42.7         46.6

5. Influence of others in choosing nursing
Parental advice                                  65.7         16.0
Ability to be with my friends who had            73.4         13.6
  chosen nursing
Career adviser's/teacher's advice                86.6          5.2

6. Travel opportunities of nursing
Opportunities for travel                         19.6         60.0

                                                If you could go back
                                                 in time, would you
                                               still choose Nursing?
                                                     (n = 1176)

                                                         No
                                                 (n = 429 or 36.5%)

                                              No / Minor   Important /
                                              Importance   Very Impt.

1. Intrinsic attraction of nursing                %             %
Interesting and challenging work                 5.1         79.2 **
Ability to help others                           6.5         79.9 **
Ability to work closely with people              12.0        72.0 **
Mentally challenging work                        11.5        63.2 **
Ability to make a strong contribution            23.2        53.7 **
  to society
Exciting work                                    23.2        50.5 **
Community respect for nurses                     28.8         45.2
The profession was perceived to carry            48.0        29.0 **
  prestige

2. Extrinsic rewards of nursing
Flexible hours of work                           33.9        42.3 **
Responsibility and autonomy in profession        34.9         36.1
Future earnings potential                        34.6         37.9
Opportunities for promotion/advancement          37.1        35.7 **
Pleasant working conditions                      37.8        37.3 **
Time required to qualify for profession          45.9         26.4
Starting salary                                  45.6         29.2
Opportunities for creativity and                 48.7        26.4 **
  originality

                                                  %             %
3. Employment security over life of nursing       5             5
Job security                                     11.2        70.0 **
Nursing skills always seemed in demand           14.0         67.9
Ability to leave the job and return later        21.7        60.5 **
Ability to combine work and family               38.8        45.5 **
  commitments
Nursing was a good career for women              33.4        43.8 **

4. Immediacy of support on entry to nursing
Training was provided on the job                 22.0         65.9
Ability to earn while studying                   23.7         65.2
Accommodation was provided while training        45.4         41.5

5. Influence of others in choosing nursing
Parental advice                                  63.7         19.5
Ability to be with my friends who had            70.8         16.2
  chosen nursing
Career adviser's/teacher's advice                79.4        9.6 **

6. Travel opportunities of nursing
Opportunities for travel                         19.3         63.0

** Significant at .05