Graduate recruitment to nursing : The information and opinions of university undergraduates on...

British Journal of Medical Education, 1973, 7 , 271-277

Graduate recruitment to nursing The information and opinions of university undergraduates on nursing and nursing as a career for graduates

A. MORRISON and P. TSEKOURAS Education Department, Dundee University, and Ninewells and Associated Hospitals, Dundee

In its recent report, the Committee on Nursing (1 972)recommendedanincreasein the proportion of graduates in the nursing profession. The Com- mittee based its arguments for more graduates - entering either through degrees with nursing studies or through shortened courses of professional training for graduate entrants - upon the need to attract into the nursing profession an increasing proportion of people able and skilled to play a major part in the development of professional knowledge and to speak on equal terms with medical and administrative colleagues in the multidisciplinary teams required to man- age an integrated National Health Service.

Graduate recruitment is, of course, only one means of meeting such needs, but up to now such recruitment has been very small. Thus a count made by the G.N.C. Research Unit in 1970 (MacGuire, 1970; MacGuire and Sparks, 1970) produced only some 400 graduates, and though numbers have undoubtedly increased since then -due in part to the greater provision of shortened courses of professional training - the proportion of graduates will continue for a considerable time to fall short of the figure of ‘between 2 % and 5 %’ of the profession envisaged by the Committee on Nursing.

It seems likely, therefore, that more attention will be paid to the means to recruit graduates. In part, increased recruitment will depend upon effective publicity and upon the availability of training facilities, but, also, it will depend upon the numbers of able and well-motivated students coming forward. At present, however, relatively M e is known about undergraduates’ knowledge ofthe nursing profession today, about their views on the graduate in nursing, or on the extent to which there is a substantial body of potentially interested students, perhaps with characteristics

that distinguish them in some measure from their fellows. The survey (Morrison and Tsekouras, 1973) on which this report is based was designed to give information on such matters, and, in turn, to use the information for suggestions about recruitment possibilities, the nature of professional training courses, and the kinds of publicity required to make students better informed about the nursing profession and the wide range of highly responsible and skilled functions within it.

The design Three universities - Dundee, St. Andrews, and Strathclyde - participated in the survey, each providing some 300 students drawn from arts, social sciences, and sciences courses, and repre- senting men and women, different year groups, and actual/intended honours and ordinary degree students. The decision to carry.out the work in three universities meant that we could represent the knowledge and opinions of undergraduates in institutions with different histories and organization, sources and patterns of local, Scottish, and English recruitment, and curricular em- phases. Furthermore, it meant that a large number of students could be sensitized to matters of nursing and careers in nursing in regional areas where professional training courses for graduates had either only been introduced recently or were still at the stage of consideration. The composition of the survey sample is shown in Table 1.

The questionnaire used in the survey was based upon an earlier version tried out on a group of social sciences students, subsequently developed in consultation with members of the nursing profession, and then checked for administrative and interpretational points with another

271

272 A . Morrisori and P. Tsekoirras

Table 1. Categories atidfreqtrencies of studenis ~ ~~ ~~~~

Total 930 Total women 402

Total Dunder 323 Total St. Andrews 305 Total Strathclyde 302 Total arts/social sciences 448

Total first year1 340 Total second year 303

Total fourth year 92

*The slight discrepancy between the total and the year totals arises from a very small number in later years.

Total men 5 2 8

Total sciences 482

Total third year 191

group of students before being used in the study. It was designed to provide information under three broad heads :

(a) Background characteristics of students - university status, career preferences, casual work experience in hospitals and clinics, personal connexions with nurses and doctors, and pre-university consideration of nursing as a possible career.

(b) Knowledge and opinions on nursing as a job and as a career for graduates - basic knowledge on such matters as qualifications, training and salaries in nursing, and opinions on working with ill people, working in institutional surroundings, and the suitability of nursing for men as well as women.

(c) Courses of professional training - knowledge of and views about courses of professional training for graduates, possible interest in nursing, and the characteristics of interested students.

Most of the items in the questionnaire required students to choose from multiple or yes!no alternatives or to make rankings, but there was also provision for open-ended responses on some topics,

One special feature of the questionnaire was that it also contained, at an appropriate point in the sequence of items, a section giving basic comparative information on training and employment in nursing and in some other major fields of employment for graduates. This section was a deliberate attempt to add to the information of students at a time when the administration of the questionnaire proper had inevitably sensitized them to matters concerning nursing. Its place in the questionnaire sequence and our mode

of administration avoided any colouring of items dealing with prior knowledge and opinions.

The questionnaire was given to groups of students by one of the authors, the groups having been selected for us by members of university staffs so as to meet as closely as possible our requirement for comparable representation of all the basic categories. This arrangement worked reasonably well, though the survey is over- represented with male students and with students in the earlier year groups, and group administration produced a full response rate as well as giving students an opportunity to discuss the questionnaire after it had been completed by them.

However carefully constructed and adminis- tered, survey questionnaires raise problems. Three of the more important concern: the hypothetical nature of some questions for varying proportions of respondents; selective retrospec- tions in dealing with information and opinions held several years before; and the danger of reading behavioural significance into expressions of interest in a course of training or an occupation. There are no simple resolutions to such problems; it is a matter for caution in making interpretations, for regarding one's questions not as independent items but as related contributions to more general themes, and for judging the validity of responses in terms of consistencies and in the light of students' manifest reactions to the task they have carried out.

Background characteristics of students To what extent did our students have personal connexions with and indirect experience of nursing? Over half of them reported qualified nurses among their families and friends; 1 student in 9 reported at least 1 parent as being a doctor or nurse; and nearly 1 in 5 said that they had some form of casual work experience of hospitals or clinics. Responses to the first and third of these were more frequent among women than men.

Other background questions concerned general occupational preferences and consideration of non-graduate nurse training before entry to university. Expressions of current occupational preferences are shown in Table 2.

This question was put in to provide a general setting to the matter of occupational preference and was not intended to do more. For our pur-

Graduate recruitment to nursing 213

Table 2. Occiipational pre ferences

Social Munage- Civil No? Orherlno % of total Teaching service Personnel ment service decided mention

All students 26 7 . 3 6 5 30 23 All women 26 9 3 2 4 32 20 All men 26 5 3 8 5 28 25 All artslsocial sciences 39 9 4 7 7 24 10 All science 14 5 2 6 3 35 351

‘Research was the most frequent other preference under this head.

poses its most interesting features were the high meaning of SRN, the length of training for SRN responses to ‘teaching’ and to ‘not decided’; and SEN, the educational requirements for entry more than half our students came into these to SEN courses, and the salary of the student categories, ‘teaching’, however, being a much nurse. They were least informed on RMN, on more frequent response for artsisocial sciences + educational requirements for SRN training. and and for female students, and ‘not decided’ being, as expected, highest in the first year, but still a quarter of second and of third year, and 14 % of fourth year (largely honours) students.

There are, of course, many reasons why students may have given particular responses - active and long-term intentions, growing awareness of occupational constraints, and deferment of expressed intention either because of lack of concern, lack of knowledge of particular open- ings, or the dependence of some intentions upon eventual academic achievement. However, the findings do suggest, as far as nursing is concerned, that there is plenty of room for opening up professional possibilities to students through publicity and other means.

The specific question on whether nurse training had been considered during the 2 or 3 years before entry to university indicated that some 13 % of all students had done so. This was predominantly a female response, a quarter of all women students. We shall come back to these findings later, but for now they add some force to the possibilities for recruitment implied in the results on general occupational preferences and on the ‘not decided’ students.

Knowledge and opinions on nursing To gain a general impression of students’ knowledge of nursing they were asked several questions about nursing qualifications, minimum educational requirements for entry to courses of training, length of non-graduate training courses, and approximate salaries in different nursing grades. Taking the questions together, then some 60 % of all students got 4 or more correct out of 9. They were best informed on such matters as the

on salaries for some senior posts. Responses over the different student categories were similar, except that women tended to be better informed on nursing qualifications, length of training, and educational requirements for entry to training courses.

The tapping of opinions on nursing and on nursing in relation to themselves was a more difficult matter, given the considerable variations in knowledge, contacts, and experience within the sample, and the hypothetical nature of some of the questions for large numbers of students who were presumably not interested in nursing as a possible occupation. In these circumstances, then, it is best to see answers to questions as reflections upon general impressions acquired about nursing as much as considered representa- tions of individual opinions. This, however, was appropriate to our purpose since we were after the kind of image of nursing prevailing in the sample. The first group of questions dealt with more general views on nursing - the worth- whileness of the job, the exposure to illness and death, the predominantly female staffing, the institutional nature of the work, and the close professional and personal involvement with others. The second group dealt with nursing in relation to expectations of university students - salary, especially in the early stages, the prospect of further extended training, the use of a university education, and prospects of advancement.

The general pattern of responses indicated that nursing was highly regarded, and that an occupation involving, as nursing typically does, close social and professional interaction, was very attractive to students. On the otherhand,about one- third of all students indicated that they would

214 A. Morrison and P . Tsekoirras

find i t personally most distressing to work with seriouslyill patients; and a similarproportion said that they would dislike working in a distinctively institutional setting. However, more light is thrown upon nursing as an occupation and as a personal career by some of the other questicns. Over half the students held the view that they would not be making the most of their university education by entering nursing; nearly 60 % held the view that nursing was more suitable for women than for men, and though more men held this opinion it was also subscribed to by 45 % of the women; further extended training was felt to be discouraging by nearly half of the students; nearly two-thirds thought initial salaries would be discouraging (though many had incorrect ideas about initial salaries or salary prospects); and there was great uncertainty about prospects for advancement for graduates in nursing.

These various results came from a body of students, in which about 1 in 7 expressed any degree of interest in training and a career in nursing. However, the impression given is that while these students had very favourable views on nursing, appreciating its value and some of its attractions, they were uncertain as to its status, training requirements, and prospects as far as they as potential graduates were concerned. Nursing was a job for other people rather than themselves. One student, in an open-ended response, expressed the position in a rather extreme form: ‘There seems to be some stigma associated with the profession in that i t is a profession for girls of no great intelligence, and to the qualified graduate the prospect of working with these people does not seem attractive.’ Another student, perhaps incidentally, reflected the limited idea of range of functions within the nursing profession which may have produced some of our findings when she wrote: ‘Do not think graduates are suitable; in general they think they know it all and resent cleaning bedpans. To get the right type emphasize the sheer physical hard work and more squalid aspects.’

Of course, not all our students subscribed to these various views - they varied in degree and by item - yet there came across from many of the responses a conception of nursing which was to a considerable degree compounded of inade- quate information, outmoded conceptions of the range of skills and responsibilities in nursing, and concern over making use of a university

education. It is a conception that seems out of touch with many features of the profession to those who are aware, for example, of the responsibilities of chief or principal nursing officers in large hospitals or groups, of the work of nurses in special units, or of teaching and research in nursing. In part, of course, some of these limited perspectives of students come simply from lack of information about nursing today, but perhaps they were also due in part to inflated notions about other professional opportunities.

Professional training courses for graduates A large majority of students were unaware that schemes for graduate entry to the nursing profession existed. Here there were major sex differences, with some 17% of men aware as com- pared to 40% of women, and, also, younger students seemed better informed than those nearer to graduation in our sample. As we mentioned earlier, the length of training, normally about two and a quarter years, was seen as discouraging by half the students, but against this, i t was generally recognized that there would need to be a substantial period of training, and some 60% of all students thought that this should be between 18 months and 2 years. There was also a great deal of agreement on the type of curriculum, with a half of all students suggesting that the emphasis should be placed upon prac- tical experience, 14 % on administration, and 6 % on theoretical knowledge - the remainder indicating no emphasis.

So far this report has looked primarily a t all students and the major categories. However, we were also concerned in the questionnaire with gauging in some degree the extent of possible interest in nursing careers among our students and with examining questionnaire responses for possible associations between expressions of interest and other characteristics of our students.

Great care must be taken over the interpreta- tion of ‘interest’; it bears a variety of meanings and intensities which cannot easily be distin- guished. On the one hand, it may predispose one to a course of action, leading perhaps to further inquiry, and perhaps then to a course of action; on the other, it may be no more than ephemeral curiosity quickly displaced by other considerations. However, it can give crude comparative information, and, if it can be shown to

Graduate recruitment to nursing 215

be associated with other measures then it is given some validity.

As mentioned earlier, some 13 :L of all students (predominantly women) reported that they had considered nurse training before entry to university. The next question asked whether nurse training had been considered since coming to university, but before the questionnaire being given. The responses are shown in Table 3, from

Table 3. Cotisideration of nurse training since coming to university

:< All students 4.6 % Male students 2.7 % Female students 7.2 7; Artslsocial science students 4.0 % Sciences students 5.2

which it can be seen that the figure dropped to some 40/, of all students, but some 7 % of women. The third question on interest asked whether, after reading the information in the questionnaire, they now felt that they might be interested in a career in nursing on graduation. This, of course, was done under particular conditions of immediate stimulus, and produced a figure of 14% (Table 4).

In numerical terms the extent of the reported

Table 4. Interest in a career in nursing oti reading the information given in the questionnaire

% All students 14.3 % Male students 13.0 % Female students 15.9 % Artslsocial science students 13.2 % Sciences students 15.4

interest at the three successive stages was 123, dropping to 43, then rising to 133. In interpreting these numbers we need to take account of the following points: the total number of students represented 1 in 4 of the totals in the categories in the three universities; interest in nursing before entering university would have been in non- graduate entry; expression of interest at the third stage was inevitably primed; and people clearly differed in the extent to which they endorsed all three stages.

However, having taken such points into account i t could be suggested that substantial interest had existed and that some of it could be revived, and perhaps could be added to, especially among men, under conditions of increased information.

The question remains, however, as to whether such expressions of interest have any significance. We could not, in our circumstances, put it to the test of actual entry to professional training, but it was possible to look at the matter of characteristics associated with interest. The main findings are shown in Table 5.

Two points should be noted about these results. First, they exceed what might be expected from a numerical bias towards women in the interested groups, and, secondly, where findings are not significant they are in the same direction as the significant findings.

These findings must be considered only as tendencies for interested students to respond distinctively to some items of the questionnaire. Such students seemed to differ most in respect of casual work experience, personal and family contacts, a greater acceptance of the idea of doing further training for a profession and greater knowledge of the existence of such training for

Table 5. Interested versus not interested students at the three response points

AJter information During Before Characteristics in qrrvstionnaire university universir.v

More casual work experience <0.01 to-01 <001 More personal connexions with nurses in family/friends < 0.05 <0.01 <001

Less distress at illness/death < 0 0 2 < 0.02 .= 0.05 Nursing as suitable for men as for women io .01 NS <001 Greater readiness to do further training < 0.0 I NS < 0.0 I

Less concerned by institutional setting for work <0.01 <0*01 < 0.0 I Less discouraged by salaries N S NS t0.01 Greater knowledge o f graduate training opportunities NS < 0-01 < 0.0 I

Higher opinion of nursing as a job < 0.0 I NS t O . 0 5

Greater liking for working with others <0.01 NS < 0.05

276 A. Morrison and P. Tsrkorrras

nursing, and on opinions about salaries and pre- ferred work settings. They did not differ from others on items of basic knowledge about nursing qualifications, training requirements or salaries in training and posts, on views about the appropriate length and curriculum of professional training courses, nor on preferences for certain types of nursing work, where general preferences placed administration, psychiatric nursing, teaching, and the nursing of sick children at the top and such areas as geriatrics, nursing of cancer patients, and midwifery at the bottom.

However, the interesting feature of these findings is as much the demonstration of such tendencies for interested students to differ from others as in the nature of these differences, for it suggests a significance to the question of interest which goes beyond the ephemeral response, and provides some basis for estimates of recruitment possibilities, and perhaps for the guidance of studentsand others in matters ofchoice, selection, and publicity.

Conclusion In considering the possible relevance of these findings both to graduate recruitment to nursing and to the wider provision of courses of professional training designed for graduates, it is worth outlining the kinds of opportunities that exist or are likely to be open to graduates entering the nursing profession. Initially these matters can be looked at in numerical terms. At present, a fractional percentage of trained nursing staff are graduate, but if one takes the figures of between 2 and 5 % given in the Briggs Report then a very large increase is being recommended. Thus, if Scotland alone were considered, with a trained nursing force (staff nurse and above) of some I 1,000, then this could mean between 200 and 500 graduates. Opportunities for able and highly skilled graduates should be very good in the next few years, and such opportunities are likely to be matched by attractive forms of employment. Some of the jobs available, such as in nursing administration, mean responsibility for policy making and implementation, day-to-day administration, and for the organization of in-service training involving large staffs - responsibility equal to or greater than that to be found in other public organizations and commercial/industrial enterprises, Again, in nurse teaching in colleges of nursing, developments in curricula and in staff

specialization will provide excellent opportunities for graduates and others who have high academic qualifications in the biological and social sciences.

Some of the problems then are not the lack of opportunities for demanding and intellectually satisfying careers but rather of attracting good applicants for professional training from the universities and other higher institutions, and of selection, publicity, and training. On some of these, and on related matters, this survey has been useful. It has shown, among other things, that many students are poorly informed or have misconceptions about aspects of nursing, and about opportunities for graduate training and prospects; that there is a view of nursing as a worth-while and satisfying job for others to do, but below their conceptions of appropriate graduate occupational status; and, that the notion of nursing as an occupation primarily for women still persists. On the other hand, it has shown that there is a substantial body of potentially interested students, some of which consists of persons with manifest interest, and some of which consists of students whose interest can be stimulated by additional, and perhaps corrective, information ; that this body substantially exceeds current proportions for graduate recruitment; and that interested students do appear to differ from others in certain characteristics. The big discrepancy between actual recruitment and some expression of interest is hardly suprising given the factors bearing upon occupational choice; however, the lateness of choices apparent for many students, coupled with the fact that expressions of preference by many for teaching are often coloured by growing awareness of occupational constraints, appears to give plenty of room for nursing bodies and university appointments boards to extend upon the publicity and advice they already give.

No survey can guarantee that its paper and pencil findings will produce entrants to professional training. In the end, any attempted projec- tions from such evidence remain speculation. Rather, the answer lies in developing the information and opinions of students in appropriate directions, in creating the training opportunities, and in matching available information on student characteristics, professional requirements, and general estimates of potential interest with local professional enthusiasm for the provision of courses for graduates.

Grarirrate recriritment to niirsing 211

Summary Relatively few graduates enter the nursing profession despite the increasing opportunities for attractive careers in such fields as administration and nurse training, and in areas of highly specialized and skilled nursing. This report, based upon a survey of undergraduates in three Scottish universities, deals with students’ information and opinions on nursing and nursing as a career for graduates. In addition to reporting upon general patterns of responses from students, and indicating some areas of misconceptions, it identifies some of the personal characteristics associated with expressed interest in nursing as a possible career. Finally, the possible relevance of

various findings to the recruitment of graduates is discussed.

References Committee on Nursing (Chairman Professor Asa Briggs)

(1972). Report of The Committee on Nursing (Cmd. 51 IS). HMSO: London.

MacGuire, J. M. (1970). Nurses and graduates, pt. 2. An attempt to locate nurses with degrees, pt. I . Nursing Times, 2 April, Occasional Papers, p. 41.

MacGuire, J. M., and Sparks, S. (1970). The nurse graduate in the United Kingdom - patterns of qualification. Inrer- national Nursing Review, 17, 350-372.

Morrison, A., and Tsekouras, P. (1973). Graduate Recruit- ment to Nursing: A Survey of the Information and Opin- ions on Nursing and Nursing as a Career for Under- graduates in Three Scottish Universities. Unpublished Report, Department of Education, University of Dundee. and Board of Management for Ninewells and Associated Hospitals, Dundee.

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