The deepening shortage of nurses is seriously compromising health care hi this country. The American Hospital Association (AHA) reports registered nurse vacancy rates averaged 11.3% in December 1987, with 78.6% of the hospitals surveyed reporting major registered nurse staffing difficulties ("Shortage worsens," 1988). Many hospitals are feeling the financial crunch from low revenues due to the necessity of closing beds ("Staff shortages," 1988). Whereas in years past hospitals had only to look to nursing educational programs for a fresh supply of graduates to fill existing gaps, this source of nurse manpower is shrinking. The National League of Nursing (NLN) reports enrollments in KN schools of nursing continue to decline with a 10% drop in 1986, followed by a 6% drop in 1987 ("Student count slipping," 1988).
Reasons for the current nursing shortage are being discussed in a variety of public media as well as nursing publications. Along with working conditions and salary, nursing's public image is being cited to explain why the profession is no longer an "attractive" career choice (Fagin & Maraldo, 1988; "Nursing shortage," 1987; Oski, 1987). Although the fact that there is a nursing shortage has been documented, the reasons for the shortage are often speculative.
A review of the literature on the image of nurses and the nursing profession reveals content that has focused mostly on what the nursing profession perceives "to be right and wrong" with nursing, how the profession thinks others perceive it, and an interpretation of scenarios from the public media (Brooks, 1989; Curran, 1985; Inlander, 1988; Kalisch & Kalisch, 1982, 1983).
The newspaper media has communicated the following to the public:
* Nursing is not a lucrative profession; even at the height of their career and after many years of experience, nurses barely make $30,000.
* Nurses are going into higher paid and higher status professions.
* Nursing is equated with day care and women feel that if they are going to work in a hospital, they should go ahead and be a doctor (Lewin, 1987).
Additional information included in the newspaper network concentrated on issues of nurses not liking to work weekends, having too much responsibility, and getting too little respect from the public and doctors ("Nurses," 1987). In attempting to analyze the shortage, this study explored the reservoir- from which most professions pull their potential candidates - high schools. The literature stated that most college students selected their career during their high school experience, and that recruiters make special efforts to mold and influence that choice through career days and academic counselors. This source of supply has not been, according to the literature and other sources, surveyed to find out what the most influencing factor is, if any, for selecting nursing as a career choice. It was upon this premise that the following research project was designed and implemented.
Using a Likert Scale format, an investigator-designed questionnaire was constructed to identify high school students' beliefs about the education, working conditions, status, and earning power of registered nurses. Subjects' demographic variables such as sex, race, and present grade level were included. All questionnaire items were designed to elicit single responses to statements about nurses and nursing. Fbrty-two items forced subjects to choose one of the following responses: strongly agree, agree, disagree, or strongly disagree. Three additional questionnaire items were constructed to identify subjects' beliefs regarding nurses' hourly wages, whether they were considering nursing as a career choice, and their primary source of information about nursing.
After review by three content experts, the questionnaire was pilot tested and then administered to high school students agreeing to participate in the study. Responses were recorded on op-scan answer sheets and subsequently scored using the National Computer Service. Questionnaire completion time for subjects averaged 20 minutes. Data were analyzed using the Statistical Package for Social Sciences and results were reported in percentages of the total number of subjects studied.
"HOW MUCH DO NURSES EARN PER HOUR?"
Subjects consisted of a sample population in grades 9, 10, 11, and 12 from three public high schools. A total of 306 students participated in the study: 78 were in grade 12; 92 were llth graders; 60 were 10th graders; and 76 were 9th graders. Girls comprised 174 subjects; 126 were boys; and 6 subjects did not specify their sex. The majority of subjects were white (219); 70 were black; 7 were Asian, and 4 were Latin/Hispanics. Five subjects specified they belonged to some other ethnic group, and one subject did not respond to the item at all.
Findings reveal that, indeed, the nursing shortage may be deeply entrenched since only 8.6% of the high school students sampled said they were considering nursing as a career choice. The majority (76.9%) are not considering nursing as their career; 14.6% responded as maybe.
The education required to become a nurse is perceived as costly and difficult, requiring a college degree. Table 1 shows subjects' response percentages to nursing education items.
Whereas fewer than 20% believe nursing education is affordable for most people, 70% believe it takes considerable money to attend nursing school. Perceptions about the time required to receive a nursing education is evenly divided in that 32% of the subjects believe it does not take very long to be a nurse and 36% think it takes too long. Subjects generally agree that nursing education requires a college degree (78%), considerable knowledge (88%), and difficult courses (66%). Although the majority of high school students sampled believe nursing to be a profession (91%), many (70%) believe it to be a technical occupation. Therefore, about 61% of the students believe nursing to be both professional and technical in nature.
As seen in Table 2, working conditions for nurses are perceived as stimulating and challenging. However, 81.9% of the subjects also believe nurses have to perform unpleasant tasks. Almost 80% do not think nurses can choose the days or hours they want to work, and more than haif of the subjects do not believe nurses can always find a job. One fifth of the subjects believe nurses spend most of their time socializing with doctors.
Perceptions of the social status of nurses, as compared with that of physicians, lawyers, and secretaries, are shown in Table 3. It should be noted that almost 30% of the subjects believe nursing to be a low status occupation; the same percentage of subjects believe the status of nurses is equal to that of physicians. Lawyers are perceived as having a higher status than nurses by a larger majority of high school students surveyed.
Table 4 depicts subjects' perceptions of nurses' hourly wages. Table 5 shows additional questionnaire items about earning power, which reveals that 50% of high school students do not think nurses get paid well, but 35% believe nurses make high salaries. Nursing is perceived as more lucrative than teaching, because 74.3% believe nurses make more money than do teachers. Slightly more than half of the subjects tested believe plumbers make more money than do nurses.
As seen in Table 6, direct encounters with nurses seem to be more influential in shaping high school students' opinions than do vicarious experiences through television and the printed media. Of special significance is that only 2.7% of the subjects said their views come from learning about nursing in school.
From the results cited above, it appears that high school students perceive nursing education to be too difficult and costly in view of the potential return on their investment in terms of status or monetary compensation. Additionally, they do not perceive a nursing career as one always offering job security.
Persons interested in recruiting nursing students may want to adopt strategies that offer potential nurses a positive, personal experience with nurses in actual work situations. Obviously, nursing needs to become more visible in high school career education curricula.
"WHAT IS THE PRIMARY SOURCE FOR YOUR VIEWS ABOUT NURSING?"
The lack of sufficient numbers of non-white subjects limits the extrapolation of this study's findings to minority population groups. Since all subjects participating in this study reside in the same middle-size urban community, it's possible that high school students from rural or larger urban areas may have different perceptions about nurses and nursing.
This study examined high school students' perceptions about nurses' education, working conditions, salary, and status. Also included were the percentage of subjects considering nursing as their career choice along with their primary source of information about nursing. Findings imply that future nurses may remain in short supply without some resolution of current issues and without major efforts to recruit potential candidates prior to their graduating from high school.
- Brooks, C.A. (1989). Nursing crisis issues. Nursing and Health Care, 10, 121-122.
- Curran, C.R. (1985). Shaping an image of competence and caring. Nursing and Health Care, 9, 371-373.
- Fagin, C.M., & Maraldo, P.J. (1988). Feminism and the nursing shortage: Do women have a choice? Nursing and Health Care, 9, 365-367.
- Inlander, C.B. (1988). The fight against powerlessness. Nursing and Health Care, 9, 385-386.
- Kalisch, B.J., & Kaliach, P.A. (1983). Improving the image of nursing. American Journal of Nursing, 1, 48-54.
- Kalisch, FA, & Kalisch, B.J. (1982). Nurses on prime-time television. American Journal of Nursing, 2, 264-270.
- Lewin, T. (1987, July 7). Sudden nurse shortage threatens hospital care. The New York Times, pp. A1-A2.
- Nurses. (1987, September 13). lhllahassee Democrat, pp. 1A-6A.
- Nursing shortage worsens. (1987). Nursing World Journal, 8, 2, 19-20.
- Oaki, FA (1987). If only all doctors felt this way. RN, August, 44-45.
- Shortage worsens "slightly': Bed closures hit big hospitals. (1988). American Journal of Nursing, 8, 1137.
- Staff shortages are closing beds in many areas. (1988). American Journal of Nursing, 6, 896, 904-906.
- Student count still slipping, says NLN. (1988). American Journal of Nursing, 7, 1028.
"HOW MUCH DO NURSES EARN PER HOUR?"
"WHAT IS THE PRIMARY SOURCE FOR YOUR VIEWS ABOUT NURSING?"