Health care is rapidly changing, requiring nursing practice to evolve to meet system challenges and respond to complex health conditions. In response to this change, nursing organizations and associations articulate that registered nurses (RN’s) need to be: leaders of system change and innovation, comfortable working within complex organizations and partnerships, generators and translators of knowledge, and stewards of resources and quality improvement activists (Canadian Association of Schools of Nursing, 2014; Canadian Nurses Association, 2009; Gallup, 2010). If this is the future and requisite standard for practice, the questions become: (1) As a profession are we attracting students who want to engage in this view of nursing practice; and (2) Are we as educators preparing future RN’s for career success? Nursing is steeped in tradition and embracing this careerist image will require a shift in thinking to a broader ideal of nursing practice, along with appropriate educational preparation. Nursing is consistently viewed as a trusted profession, but not one whose members engage in leadership and health care transformation (Gallup, 2010). Literature has confirmed students choose a career in nursing based on altruism and personal aspirations to help people (Price, McGillis, Hall, Angus & Peter, 2013; Wilkes, 2014). There is an identified need in the literature to ascertain how nursing students perceive the role of the RN in comparison to evolving roles and responsibilities Bolan & Grainger, 2009; Johnson & Cowin, 2013). The purpose of this study is to answer the following questions:
1. How do students entering a baccalaureate program view the role of the RN in the current health care system?
2. Do these students demonstrate a willingness or desire to participate in the role of RNs as envisioned by nursing leadership bodies?
3. How do the perceptions and career aspirations of first year students compare to those of students nearing the end of a four-year program?
Methods:
This is an exploratory study utilizing an on-line survey and focus groups to better understand the perceptions and career goals of students. The on-line survey was sent using official university email addresses to all new students entering a four-year degree program and students in the final semester of the degree program by a program assistant to maintain the privacy of student email addresses. The survey contained a mixture of personal opinion, ranking and short answer questions. Students were sent reminder emails at one-week intervals for the four weeks the survey was available. At the end of the survey students were invited to participate in focus groups. If they were interested they sent the researchers an email address for communication. All focus group participants were given a prepaid $50.00 Mastercard as compensation. Focus groups were held separately for new and fourth-year students at the university. Quantitative data from the surveys were analyzed using a SSPS, while thematic analysis was conducted on the short answer questions and the focus group data.
Results:
Results from the survey of students accepted into the BScN program confirmed previous findings that altruistic motivation is a key factor in career choice, along with a personal aspiration to help people. Achievement of career aspirations revolve around ‘making a difference’ with patients in an acute care setting. Further exploration through focus groups identified that these students do not view RNs as leaders within health care teams or health care systems. They further articulated the roles and responsibilities of the RN to be that of a ‘worker bee’ primarily carrying out the orders of others. A fear of being in charge and having the responsibility to make decisions was articulated. While some students expressed interest in a scope of practice beyond the bedside, as envisioned by nursing leadership in Canada, most of them continue to aspire to a career focused on individualized, acute care provided in institutions.
In comparison, data collected from students near the end of the BScN program reveal some change in thinking about the role of the RN. While these students recognize leadership and expanded roles may be within the role of the RN, most were not interested in pursuing these roles or lacked personal confidence in their own ability. The theme of ‘maybe RNs do this, but NOT me’ was prevalent. Even when recognizing that RNs make take on leadership roles, students expressed the belief that RNs were only capable of leading other RNs and should not attempt to lead other health care practitioners. In addition, a new theme emerged across both cohorts. There appears to be a shift in altruistic motives in choosing nursing as a career to one of personal affirmation. Student responses confirmed that they want to make a difference but need affirmation that they are indeed helping others and changing lives.
Conclusion:
Neither new students or fourth-year students embraced the role of RNs outlined by leadership nursing bodies, but instead wanted a career very similar to traditional nursing practice. Even an educational program that aims to provide a broad view of nursing practice and prepare students to take on leadership roles in order to influence health care systems and challenge the status quo, did not change students' views much. Stereotypical views of nursing practice are deeply entrenched in the image of nursing and nursing educational practices seems to reinforce these views. Next steps for this research is to compare the results from students at one university with similar university to determine generalizability of findings. The aim of this research is to influence recruitment initiatives, perceptions and image of nursing, retention strategies and curriculum review and development in order to achieve changes to nursing practice articulated by leadership nursing groups. While this study is focused on Canadian nursing students the results could shape the nursing profession worldwide as the current image and view of RN roles and responsibilities can hamper the recruitment of leadership-minded students into nursing throughout the world. As the health care workforce becomes increasingly global it will be important to understand and influence perceptions of nursing in countries around the world.