Individual values are strong indicators of professional performance. This study examined the values profile of nursing undergraduate students, as measured by the 20 life and work values from the Values Scale (Macnab, Fitzsimmons, & Casserly, 1985), and compared their profiles to those from a comparable sample of management undergraduate students. This article presents the findings of this study regarding values among nursing and management undergraduate students. Specifically, it discusses several significant differences among values identified by the students, particularly two values deemed most important by nursing students, and offers specific recommendations for nurse educators and managers.
For the past 6 decades or so, educators, counselors, and researchers have focused much attention on life and work values. Until his death in 1994, Super (1957) was a major figure in the values field, with his extensive conceptual and empirical work. Essentially, Super (1973) viewed values as "objectives that one seeks to attain to satisfy a need" (p. 190). In addition, values permeate all aspects of life, including vocational choice and work values (Super, 1957). Super's (1970) empirical work resulted in the Work Values Inventory (WVI). This popular instrument measures 15 values affecting the motivation to work. Expanding on existing work and recognizing the need to update instruments given societal changes, the Work Importance Study (WIS) (Ferreira-Marques & Miranda, 1995; Fitzsimmons, Macnab, & Casserly, 1985; Macnab, Fitzsimmons, & Casserly, 1987; Super & Sverko, 1995) began in 1979, under Super's guidance, as an international effort involving psychologists from 17 countries around the world, including Canada, seeking to better understand work and life roles.
One major outcome of this international undertaking was the Values Scale and, later, the revised Life Roles Inventory-Values Scale (LRI-VS) (Macnab et al., 1985, 1987), which reflected, in part, social changes since the 1970s. The LRI-VS contains 100 items accommodating 20 values (5 items per scale). Sample items from the 20 values scales are shown in Table 1. These 20 values form five factor-analytically derived, higher-order components (Macnab et al., 1985) as follows:
Sample Items From the 20 Values Scales
* Personal Achievement and Development (i.e., Ability Utilization, Achievement, Advancement, Authority, Prestige, Personal Development).
* Social Orientation (i.e., Altruism, Aesthetics, Social Interaction, Social Relations).
* Independence (i.e., Autonomy, Creativity, Life Style, Variety).
* Economic Conditions (i.e., Economics, Working Conditions, Cultural Identity).
* Physical Activity and Risk (i.e., Physical Activity, Physical Prowess, Risk).
It should be noted that the LRI-VS is identical to the Values Scale (Nevill & Super, 1986), except the LRI-VS includes the Cultural Identity and Physical Prowess values in addition to the 18 values common to both scales. Casserly, Fitzsimmons, and Macnab (1995) provided a concise description of the Canadian study of the Values Scale aspect of the WIS.
The LRI-VS has been used with various adult populations. For example, it has been used with students (Madill, Macnab, & Brintnell, 1989), occupational therapists (Madill, Vargo, & Brintnell, 1990; Taylor, Madill, & Macab, 1990), and women reentering the workforce (Shapiro & Fitzsimmons, 1991). It is recognized that values are formed in life through institutions such as family, school, and church, as well as by life experiences. However, some values alter over time as a consequence of life and work experiences. Following their review of the Canadian work on the Values Scale, Casserly et al. (1995) concluded that:
The psychometric properties of the LRI Values Scale and the LRI Salience Inventory indicate that the instrument has good structural reliability and validity characteristics for these [Canadian] populations. It is now being used in secondary schools and universities across Canada and in many career counseling offices. It has been put to particular use in rehabilitation centers where adults are forced to make major decisions about new directions in their lives. The LRI measures have already proved useful.. .in counseling adults about midcareer change, midcareer evaluation, labor force or employment entry, education reentry, and retirement and preretirement (p. 126).
Recently, Niles and Goodnough (1996) provided a detailed overview of several studies using scales from the WIS, all of which were conducted in English-speaking countries, including Canada. Results from these types of studies showed the LRI-VS can be used in a variety of counseling applications with adults. According to Niles and Goodnough (1996):
It can be argued that there is research support for using the Values Scale and the Salience Inventory in career counseling to expose potential areas of difficulty (e.g., home and work role conflict), uncover potential areas of difficulty in career development (e.g., limited life-role salience), and make connections between values and specific steps in the career planning process (e.g., using career information) (p. 83).
Central to this study are the psychometric findings on the LRI-VS because only instruments yielding scores of known and strong psychometric properties, particularly regarding reliability and validity, should be considered for use (Flynn, 1994). Various studies report support for reliability and validity of the scale. For example, Macnab et al. (1987) noted that internal consistency reliabilities for the 20 values with different adult samples tend to fall in the range .64 to .91, with median Cronbach alpha coefficients in the range .80 to .83. They also reported that factor analyses, typically principal components analyses, at the item level show support for approximately 14 of the 20 a priori values and that factor analyses of the 20 scales suggest the 20 values group into five major value components as noted above.
This study focused on nursing, and one can easily suggest several values that should be rated as important, simply from knowing the occupational stereotype associated with nursing and recognizing that nursing is still predominately a female profession in North America (Gatton, DuBois, & Faley, 1999). For example, there is a large literature on sex-typed norms, suggesting women express greater warmth, expressiveness, nurturance, emphasis on social relations, and concern for others than men (e.g., Bern, 1974; Super, 1957; Super & Sverko, 1995; Wood, Christensen, Hebl, & Rothgerber, 1997). Moving from sex-type norms to the broader phenomenon of occupational stereotyping based on gender, nursing has been and continues to be viewed as a woman's profession. For example, Glick, WiIk, and Perreault (1995) studied the attributes most frequently associated with selected occupations, including nursing, by samples of undergraduate students. Not surprisingly, the most frequently reported attribute for nursing was "female," followed by "nurturant." In addition, one would expect altruism (Batson, 1991; Rushton, 1980) to be important because nursing is considered a helping profession in which nurses are in direct contact with patients in pain and suffering and involving shift work, as well as other selfless work behaviors for patients' benefit.
Although several authors (e.g., Boughn & Lentini, 1999) identified values of importance to the nursing profession, and a few researchers pursued specific values of interest, no researchers endeavored to establish a profile of values essential to nursing practice. In addition, no research was found that used the work of Super (1973) or the WIS (Super & Sverko, 1995). Nevertheless, many of the values that have been studied individually are among those identified by Super (1973) and Fitzsimmons et al. (1985) in their work. For example, researchers tend to explore the values of altruism or caring (Boughn & Lentini, 1999; Fagermoen, 1997) and often the values of autonomy (Ballou, 1998; Boughn, 1995; Tompkins, 1992; Webb, Price, & Coeling, 1996), achievement (Saarmann, Freitas, Rapps, & Riegel, 1992), and authority (Webb et al., 1996).
A body of literature related to the topic of values addressed the reasons individuals select nursing as a career and the developmental processes of being socialized into the profession. For example, recounting several decades of nursing, 15 nurses in Magnussen's (1998) study indicated nursing offered a practical career, viewed as "satisfying, flexible, accessible in terms of cost of schooling, always in demand and respectable... [and] regardless of the era, it is linked with the caring role of women and therefore attracts those who are interested in working with people" (p. 182). Holland (1999) described the social and academic processes of learning to become a nurse. Her findings closely paralleled those of Reutter, Field, Campbell, and Day (1997). Reutter et al. (1997) described learning experiences as nursing students are socialized throughout a 4-year baccalaureate program, "In the first year, functionalist learning predominates as students learn the 'ideal' norms and values of the profession... [while fourth-year students] are active in seeking out learning experiences that will prepare them for this new reality as graduate nurses" (p. 154). Essentially, students adopt professional values throughout their educational program. Reutter et al. (1997) concluded that students "do not seem to abandon the professional values inculcated by the professional school. ..[and] do not assume the burreaucratic values of the organization" (p. 154). More important, "they do not 'give in' to the norms and values of the nursing unit when these are discrepant with the values and norms conveyed by the faculty" (Reutter et al., 1997, p. 154), despite a desire to "fit in."
At the graduate level, Pelletier, Donoghue, Duffield, and Adams (1998) distinguished between personal and professional growth. According to Pelletier et al. (1998), personal growth pertains to:
the effects of studying on their family and social activities, and on their development of objectivity, insight, self confidence and esteem... [whereas professional growth includes] participation in nursing organisations, number of conference presentations, research activities, publications and mentoring behaviours (p. 27).
Although the examples of personal growth can be readily applied to most undergraduate students, it is unlikely the majority of students would demonstrate similar professional growth. Tb undergraduate students, professional growth tends to reflect gaining insights into the culture of the profession (e.g., symbols, rituals, shared meanings) and developing competence in performing nursing acts. In contrast to nursing, the stereotypical view of business professionals is that of highly competitive risk takers who are concerned with their own personal advancement, rather than about others.
Instead of simply examining a variety of values in a disjointed manner, some researchers examined the profile or pattern of values or value systems that characterize, for example, different cultural, national, or occupational groups (e.g., Super & Sverko, 1995). Therefore, the main purpose of this study was to identify the values profile of a sample of nursing undergraduate students, with particular attention to those values considered highly important. It was hypothesized that the values fitting the occupational stereotype (e.g., Altruism, Social Relations, Social Interactions) would be evaluated as important (i.e., have means greater than 15, equal to an importance score of 3 on each of the 5 items per scale), while values unrelated to the occupational stereotype, specifically, Physical Activity, Physical Prowess, and Cultural Identity, would be evaluated as relatively unimportant (i.e., have means less than 15). Risk, in the sense that risky behaviors should be avoided in health care, should be evaluated as important. Given that these participants were in a university degree program, it was hypothesized that Personal Development, Achievement, Ability Utilization, Autonomy, and Prestige would be evaluated as important.
A secondary purpose of this study was to contrast the nursing profile with that obtained from a comparable sample of management undergraduate students. Given the occupational stereotype that management or business people are competitive and motivated by economic and other personal gains (e.g., promotion), it was hypothesized that the nursing sample would have a significantly higher mean than the management sample on Altruism but lower means on Economics, Advancement, Authority, Life Style, Risk, and Autonomy.
The final purpose of this study was to explore the relationship between age and these values because the program at the authors' institution attracts not only traditional students (i.e., students who have entered the university directly from high school), but also nontraditional students, who have a college diploma in nursing or other work and life experiences and who wish to earn a university degree in nursing. These nontraditional students are older and may have different importance ratings on at least some of the values, given their additional work and life experiences.
The design of this study was comparative, descriptive, and non-experimental in that no circumstances or variables were manipulated. Actually, the study of values does not lend itself to an experimental approach because values are stable characteristics in adults. In descriptive designs, bias may be avoided through conceptual and operational definitions of important variables, selection of sample and size, valid and reliable instruments, and meticulous data collection procedures (Polit, Beck, & Hungler, 2001). The population of interest was undergraduate students in a liberal education university. Therefore, undergraduate students taking courses offered by the two researchers provided a convenience sample.
The study was conducted at a small, liberal education university in western Canada. The total sample consisted of 272 (reduced to 263 due to missing data) volunteer undergraduate students majoring in either nursing (n = 152) or management (n = 111). These students were professionals-in-training taking courses taught by the authors. This activity was part of a course-related exercise in discovering one's own work and life values, followed by class discussion on values.
The mean age for the total sample (N = 263) was 25 (SD = 7.5). The majority of students were women (n = 180, 68.4%), and the remainder were men (n = 83, 31.6%). Most students (n = 111, 42.2%) were in the final year of their programs. However, 72 (27.4%) and 74 (28.1%) were in the second and third years of their programs, respectively. A few (n = 6, 2.3%) were in the first year of their programs. The majority of the students were White, but several other ethnic groups were represented (e.g., Chinese, Aboriginal Canadians). However, specific details were not collected as part of the demographic information.
Instruments and Procedure
Participants completed the 100-item LRI-VS in class under emotionally neutral, untimed conditions. Each item is a brief phrase in response to the fragment, "It is now or will be important for me to...." The 4-point Likert-type response alternatives include 1 = of little or no importance, 2 = of some importance, 3 = important, and 4 = very important. The LRI-VS requires approximately 15 to 20 minutes to complete. For each of the 20 values, participants receive a score that equals the total of the five items for the value. Therefore, the total score for each value ranges from 5 to 20. The higher the score, the more important the value is to the participant. In addition, because self-report measures are susceptible to social desirability, a form of response bias, participants also completed the widely used 33-item Marlowe-Crowne Social Desirability scale (MCSD) (Crowne & Marlowe, 1960) on a separate occasion.
The means, standard deviations, and Cronbach alpha coefficients were calculated separately for the nursing and management samples. The values profile for the nursing sample was formed by rank ordering the values based on their means from the largest mean (reflecting the most important value) to the smallest mean (reflecting the least important value). Given the 4-point scoring system noted above, means of at least 15 (i.e., 5 items multiplied by 3, the score indicating "important") indicate an important value. In addition, the values profile for the nursing sample was compared to that for the management sample using t tests with the Bonferroni adjustment to control for Type I error, given that 20 t tests were performed.
An exploratory analysis of age regarding these values was performed because the program at the authors' university attracts both traditional and nontraditional students. The nontraditional students may have different importance ratings on at least some of the values due to their additional work and life experiences. Correlational analyses between age and scores on the 20 values would identify such age effects. Scores on the MCSD were correlated with scores from the values scales to detect social desirability in responding as would be indicated by significant positive correlations.
Descriptive and Reliability Statistics for Scores From the 20 Values Scales
The descriptive (means and standard deviations) and reliability (Cronbach alpha coefficients) statistics for scores from the 20 values scales for the nursing and management samples are shown in Table 2. The alpha coefficients for the nursing undergraduates ranged from .63 to .90, and alpha coefficients for the management undergraduates ranged from .61 to .86. These alpha coefficients are similar to those cited in the instrument manual (i.e., .64 to .91). (Macnab et al., 1985).
Values Profile of Nursing Undergraduate Students
As shown in Table 2, Personal Development (mean = 18.51) and Altruism (mean = 18.37) clearly are the most important values for this sample of nursing undergraduate students. Social Relations, Ability Utilization, and Achievement are also important values, given their mean values of more than 17. Physical Activity, Economic, Social Interaction, Prestige, Aesthetics, and Autonomy are of some importance (i.e., their means exceed 15). The values of Advancement, Variety, Authority, Working Conditions, and Life Style are of only slight importance, with means between 14 and 15. Finally, Cultural Identity, Creativity, Physical Prowess, and Risk are relatively unimportant for these nursing students.
Descriptive and Reliability Statistics and Nursing Versus Management Profile Comparisons
Relationships Between Age and Values
Significant negative correlations were found between age and Social Relations (-.37), Altruism (-.35), Social Interaction (-.35), Cultural Identity (-.24), Advancement (-.20), Physical Activity (-.18), and Aesthetics (-.17), indicating that younger nursing students rated these values higher in importance than older nursing students. However, these correlations were small to moderate in size, accounting for only 3% to 14% of the variance in the relationships as indicated by r2 values.
Nursing Versus Management Samples
The means and standard deviations of values scores for the management sample also are shown in Table 2. The results of the t tests for sample differences in values scores are included in Table 2, and it should be noted that the Bonferroni adjustment was made to control for Type I error rates, given that 20 t tests were performed. The t tests showed that the nursing sample had a significantly higher mean on the Altruism value and significantly lower means on the Life Style, Advancement, Autonomy, Authority, Creativity, Economic, and Risk values. It should be noted that the nursing (mean = 25.45, SD = 8.67) and management samples (mean = 24.30, SD = 5.66) did not differ on age (t = 1.19, p > .05).
There were trivial correlations (-.04 to .17) between scores on the MCSD (mean = 16.16, SD = 4.41) and scores on the 20 value scales, suggesting that values scores were essentially independent of social desirability in this study.
Findings from this study fit the occupational stereotype and sex-type norms associated with nursing, recognizing the high value placed on altruism, along with high professionalism (e.g., Batson, 1991; Bern, 1974; Fagermoen, 1997; Rushton, 1980; Super & Sverko, 1995; Wood et al., 1997). The contrasting values profile between the nursing and management samples further accentuated the stereotypical view of the nursing profession. Personal Development, rated as the most important value by nursing undergraduate students, reflects a basic need and lifelong goal of human beings, simply to "develop as a person" (Macnab et al., 1985, p. 13). A major focus in Personal Development is determining an occupational role, allowing a blending of personal and professional development. Generally, professional aspirants select their career paths with deliberate attention to their learning needs. They acknowledge that a gap exists between their personal knowledge, skills, and attitudes and those required of professional practitioners, as described by Holland (1999). Therefore, it is not surprising that Personal Development was rated so highly, given that these individuals are enrolled in the university to pursue their chosen career goals. Typically, and consistent with Koerner (1996) and Dose (1997), undergraduate students consider professional growth to be intertwined with personal growth, although they do not always distinguish among the self, profession, and institution of employment, with varying values, expectations, and demands.
Reutter et al. (1997) concluded that undergraduate students tend to remain steadfast to their personal values when they graduate. If this finding is consistent across other nursing student groups, individuals currently entering nursing programs will retain their focus on Personal Development and all this value entails (e.g., lifelong learning). Nevertheless, as Reutter et al. (1997) explained, undergraduate students do not accept professional values without serious reflection and critical examination regarding how those espoused values fit with the realities of various practice settings. In addition, Magnussen (1998) suggested that Personal Development also may be discussed in terms of nursing undergraduate students preparing themselves to meet the needs of society. Reflecting the emphasis given to Personal Development in this study, Magnussen (1998) found that the participants did not envision themselves as skilled workers or professionals as much as they contemplated doing what was necessary to prepare for their careers (i.e., developing as a person). Their most important goal was "the desire to be of service" (Magnussen, 1998, p. 176). This goal kept the students going through the difficult moments in their careers. In this study, attention is given to Altruism because this value is paramount in nursing and because of the differences noted when age was taken into account.
It is interesting to note the age effect- that older participants tended to value altruism and several extrinsic values (e.g., Social Relations and Advancement) less than younger participants. One could speculate that the older participants in this study were somewhat less "other" oriented simply because values tend to change during the course of one's life. This finding is consistent with that of Prince-Gibson and Schwartz (1998), who recognized that age is one of the major moderators of values, along with education and ethnicity. Perhaps greater life experiences encourage, if not require, older participants to prioritize individual and family obligations ahead of occupational responsibilities.
Additional support derives from the work of Sagie and Elizur (1996), who "hypothesized that the two obligatory life areas: life in general (home and family) and work, will each occupy a distinct layer" (p. 576), with the general life area being more important and "wider" than the work area. Similar to Boughn and Lentini (1999), Sagie and Elizur's (1996) findings help explain the reason older students tend to place less emphasis on extrinsic values within the work setting. Older students may perceive their professional roles in terms of monetary outcomes as much as, or more than, serving or caring for others. In addition, older professionals are less inclined than younger professionals to seek social relationships among their colleagues. Nevertheless, Boughn and Lentini (1999) found that 16 undergraduate students (4 from each class level, with an age range of 18 to 40) clearly and directly identified altruism as a strong motivating factor for choosing nursing as a profession.
Although the altruistic aspect of nursing is an essential characteristic of the profession, one must be careful to maintain a healthy balance between an "other" orientation and a "self orientation (i.e., between altruism and egoism). For example, Fagermoen (1997) noted that "values are inherent in developing and sustaining professional identity" (p. 436) and concluded that "altruism, the moral orientation of care, was the overall philosophy, and human dignity appeared as a core value" (p. 434). Historically, nurses, who are predominantly women, have been socialized to view nursing roles and functions as opportunities to care for others (i.e., to demonstrate altruism). However, current circumstances within the constantly changing health care system, resulting in loss of nursing positions and tremendous insecurity regarding positions, may stimulate nurses to contemplate their professional careers and invest themselves less in their professional roles (Crigger, 1997). Therefore, inadvertently, the larger health care system, not the profession of nursing, may influence the largest group of health care professionals, nurses, to alter their perspectives toward the value of altruism in practice.
In addition, after an exploration of literature on work values and ethics, Dose (1997) commented, "It should be recognized that advocating certain values does not mean adherence necessarily follows. Although altruism is highly regarded, for example, it is not always practiced" (p. 230). Nurse educators and practitioners must review the essence of nursing within the context of current work settings and alter practice expectations so nurses may achieve balance and harmony within their personal and professional lives. The outcome should allow nurses to "know and honor their own values by living authentic, courageous lives through making career choices that are congruent with their values" (Koerner, 1996, p. 69). Nurses also must attend to the self, in terms of physical, psychological, and spiritual health. Therefore, specific recommendations can be posed for nurse educators and managers.
RECOMMENDATIONS FOR NURSE EDUCATORS
Given the importance of values to the nursing profession, the following recommendations are offered for nurse educators.
Early in their educational program, nursing students should complete an exercise on values as a self-discovery and self-assessment exercise. Only with self-knowledge can one then act to change not only oneself but the organization, profession, community, and society in which one lives and works. Educators must be careful to ensure that such exercises are conducted in a safe, non-threatening situation where the confidentiality of all data and participant information is assured.
Students should receive not only their scored values exercise but also information about life and work values, including a select bibliography for interested students to pursue, and ample opportunity for class discussion of the role of values in nursing. Guidelines should be provided for students who wish to actively change their values. For example, select bibliographies on personal change and community resources, such as counselors, should be offered.
Given the low importance ratings for values such as Risk and Creativity, some skills training related to these values could ensure students have professional-level skills before entering the nursing profession. For example, skills training that links decision making, risk analysis, and ethics would help ensure students develop effective risk management skills before entering a health-oriented workplace. Skills training in creativity and critical thinking should help create nurses who do not simply follow work routines but think about more effective or efficient, and creative, ways of working.
RECOMMENDATIONS FOR NURSE MANAGERS
Similarly, the importance of nursing values in professional socialization leads to the following recommendations for nurse managers.
Role of Training and Development
Skills training, as described above, should benefit nurses, especially those being developed for managerial positions. Emphasis should be placed on understanding how personal values need to be integrated into organizational values. In addition, nurses need to be aware of the potential for conflict between individual and organizational values and how to resolve these differences. Given the multidisciplinary nature of current health care systems, it is imperative that managers be prepared to continue the role of training and developing all nurses within their organization.
Although the occupational stereotype of nursing may predominate in health care organizations, there are good reasons to change an organizational culture so the role of nursing includes a strong emphasis on individual and occupational empowerment, marked by participation in organizational decision making, problem solving, and innovation - directions that should contribute to greater organizational effectiveness and greater job satisfaction for nurses.
Managing Occupational Stress
The valuing of altruism, combined with the pressures of working in understaffed units, results in high and chronic job stress for many nurses. Nurses should be sensitized to the need to care for oneself. A physically and emotionally exhausted nurse is of no help to others. Organizations need to provide timely (i.e., proactive, preventive) and effective support services to nurses, such as those included in broad-based employee assistance programs.
As individuals and professionals, nurses live and work in various social structures. Currently and more than ever, the institutions that provide opportunities for employment and opportunities for individuals to realize their professional dreams are also the institutions that create demanding work environments, fraught with uncertainty and chaos within a constantly changing society. Personal values become even more significant for individuals as they learn to cope with the realities of the 21st century work setting. In analyzing the concept of autonomy, Ballou (1998) made an insightful comment:
Autonomy [like any other value] is not given or taken away; it is a personal quality that hinges on individuals' a priori inherent potential to choose a course of action. Truly autonomous individuals know and live what they believe to the extent that external forces cannot control or adversely influence them (p. 105).
Inevitably, values compel individuals to be and to act, both personally and professionally. It is imperative that nursing students clearly understand their own values and those of their chosen profession so they may realize the challenges and rewards of the caring profession of nursing.
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- Wood, W, Christensen, P.N., Hebl, M.R., & Rothgerber, H. (1997). Conformity to sex-typed norms, affect, and the self-concept. Journal of Personality and Social Psychology, 73, 523-535.
Sample Items From the 20 Values Scales
Descriptive and Reliability Statistics and Nursing Versus Management Profile Comparisons