The current shortage of nurses nationally has placed many health care institutions in crisis situations. One factor contributing to the nursing shortage has been the declining enrollments of recent high school graduates in schools of nursing. There are two major reasons for this decline. First is the declining number of high school graduates, which is predicted to continue until the mid-1990s (Department of Health and Human Services [DHHS], 1990). Second, fewer students are choosing nursing as a career and are opting for perceived higher paying or more prestigious professions such as business, law, and engineering (AACN, 1988; Astin, 1985; Green, 1987).
In 1989 baccalaureate nursing student enrollment increased by 6.8% (National League for Nursing, 1990) after a decline in enrollments from 1984 through 1988. The U.S. Department of Health and Human Services predicts a stabilization of nursing graduations in the early 1990s with a drop again in the mid-1990s as the high school population decreases. In addition, it is predicted that by the year 2000 there will be a shortage of 300,000 registered nurses, increasing to over 800,000 by 2020 (DHHS, 1990).
Historically, the majority of baccalaureate nursing students have been recruited from high schools (Vaughan, 1991). Although many nontraditional and seconddegree students are pursuing a baccalaureate degree in nursing, high schools remain a significant pool for potential nurses.
Career counseling has long been a designated function of the high school guidance counselor. Unfortunately, guidance counselors are often not well informed regarding the opportunities available to today's nurses (Williams, Morgan, & Best, 1991). Consequently, prospective nursing students who are making career decisions may be lacking some important information.
Guidance counselors are important influences in the career decisions of high school students and, therefore, are valuable recruitment targets for nurse educators. It is important that counselors have positive attitudes about nursing and be well informed about the opportunities a career in nursing can provide.
The purpose of this study was to examine the targeted high school guidance counselors' attitudes about nursing as a career and those counselors' perceptions about which high school courses are needed as basic preparation for a nursing curriculum.
Review of the Literature
Grossman, Arnold, Sullivan, Cameron, and Munro (1989) and Hendrickx (1989) reported that high school students have misperceptions about the expanded role of nurses and the opportunities for advanced practice. A significant relationship was found between students having a role model who is a nurse and consideration of nursing as a career (Grossman et al.; Hendrickx). While peers and parents have been identified as important influences in students' career decisions (Saltici, 1986; Woelfel & Haller, 1971), guidance counselors have a responsibility to provide career information and to direct students appropriately through a college preparatory course of study. High school students have identified guidance counselors as playing a major role in their career decisions (Boyer, 1988; Noeth, Engen, & Noeth, 1984).
As important influences to potential nursing students, guidance counselors have been identified as an important link in providing an accurate picture of nursing to high school students. However, counselors may not always have the accurate picture themselves. Counselors have referred to nursing as a "stepping stone to medicine" rather than a career choice itself (Malliso n , 1986).
King and Sherman ( 1990) reported that high school students attending a job fair were not well informed about nursing as a promising career. These same students reported that their guidance counselors were not actively promoting careers in nursing despite being well informed about the national shortage of nurses and the diversity of nursing education programs and nursing practice roles.
Williams et al. (1991) explored high school guidance counselors' perceptions of baccalaureate degree nursing as a career choice and determined that counselors need to be updated regarding requirements and the scope of professional nursing practice. Results indicated that the counselors were aware that college preparatory courses with an emphasis on science and mathematics were prerequisites for admission to baccalaureate nursing programs.
The questionnaire used in this study was designed for a similar study in which high school students' perceptions of nursing as a career were examined (Grossman et al., 1989). Questions on the original tool related to demographic information and specific career choices of the high school students were deleted for use with the guidance counselors surveyed. The questionnaire has established validity from Grossman's work and was found to have a reliability of .8516 with the guidance counselors in this survey.
The questionnaire used in this study asked for the counselors' opinions about opportunities provided by a career in nursing. Total opinion scores were determined by assigning points for each answer as follows: yes =4, somewhat =3, unsure = 2, and no = 1. Questions to gather demographic information were included. Questions were added regarding gender, whether or not the counselor had a family member or a friend who is a nurse, whether or not the counselor recommends a career in nursing to high school students, and which courses the counselor recommends as prerequisites for nursing.
Questionnaires were sent to all the high school guidance counselors in the states of Wisconsin and Minnesota (N= 1027X Questionnaires were returned by 517 guidance counselors for a 50% response rate. Of the questionnaires returned, 342 (66%) were from men and 171 (33%) were from women (four did not indicate gender). The majority of the guidance counselors had a family member or a friend who was a nurse.
Perceptions of guidance counselors
Most (96%) of the guidance counselors surveyed reported that they do recommend nursing as a career to high school students. When asked their beliefs about a career in nursing, the majority of the counselors perceived a career in nursing to provide an opportunity to help people live healthy lives and care for individuals, families, and communities. They indicated that nursing was a prestigious profession, that nurses are sought after and are free to change career focus.
The guidance counselors perceive nurses to have a leadership role, in that a career in nursing provides the opportunity to be an executive, to have financial success, to teach in a college, to manage large groups, to influence national health policy and legislation, and to have an impact on instructional health care. Research was seen by the guidance counselors as an opportunity in nursing and so was becoming a master at technical instrumentation.
Significant gender differences were found for four of the beliefs about nursing at a p level of <0.05. These were that a career in nursing provided the opportunity to influence policy legislation, teach in a college or university, design and direct health programs, and to have an impact on international health. The female guidance counselors had a more positive perception than the men on all four items.
The majority of the guidance counselors (n = 478) recommended that students take college preparation courses including science and math. A third of the counselors saw a need for social sciences such as psychology (n = 178) and a third (n = 134) recommended a foundation in English skills. A need for computer skills was seen by 14% of the guidance counselors (n = 73). A small percentage recommended courses in foreign language or humanities.
The findings from this study indicate that these Midwestern high school counselors are well informed about the opportunities in nursing. The guidance counselors' responses indicate that they perceive nursing to be a career that provides opportunities to work with people to promote healthy lifestyles, to assume leadership roles, and to have flexibility in work settings and positions. Almost every counselor who completed the survey does recommend nursing as a positive career choice.
It is interesting to note that female guidance counselors had a more positive view of the leadership opportunities in nursing than did the male guidance counselors. The finding suggests a possible gender bias of male counselors toward nursing. One wonders if the finding is related to a male view of women's roles in general and, in turn, of nursing, since it has traditionally been predominantly a women's career. The notion needs further exploration.
It is reassuring that most counselors surveyed are aware of the need for a strong academic background to succeed in nursing education and recommend a sound foundation in science and math. It seems that nursing educators need to continue to emphasize the need for effective writing skills as well as a broad base in the humanities for potential nursing students. An emphasis also needs to be placed on competent computer skills.
Implications and Summary
We should celebrate the fact that these guidance counselors are informed about the opportunities available from a career in nursing and are knowledgeable about the education base needed for nursing education. We need to continue to reach guidance counselors and teachers of younger children.
This study did not explore the issue of gender bias. We do not know if guidance counselors promote the career of nursing to both genders equally. Another limitation of this study is the lack of generalizability due to the use of a convenience sample selected from a portion of the Midwest. As the demand for nurses continues at a critical level, nurses need to continue efforts to promote the career of nursing and to keep recruitment at a high priority. We need also to continue to assess the effectiveness of our efforts and explore recruitment strategies.
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