What Motivates People to Start a Graduate Entry Nursing Programme: An Interpretive Multi-Centred Case Study

Abstract

Introduction

While graduate entry nursing programmes are well established in the United Kingdom and the United States of America (USA), they are relatively new to New Zealand and Australia. These programmes have been developed to meet the demands of the health workforce and provide graduates an alternative pathway to becoming a RN. Nursing is viewed as an attractive career option for this growing market of graduate entry students.

Objective

This study explored the motivations underpinning students choosing a graduate entry MNSc degree over a traditional undergraduate nursing programme.

Methods

A qualitative, longitudinal single case study design, informed by Yin was used. The first phase of the study is reported here. All students commencing a MNSc degree at the beginning of 2020 across four education providers (3 in New Zealand & 1 in Australia) were eligible to take part in the study. Ten students agreed to take part and undertake an interview. Braun and Clarke’s approach to thematic analysis was used to analyse the interview data.

Results

Three key themes of motivation were identified from the data: the attraction of nursing; the clarity nursing offers in terms of career progression; and the design of the intensive programme.

Conclusions

The motivations to choose a MNSc degree were deeply considered, multifaceted, and influenced by nursing role models. Students wanting to engage with a graduate entry MNSc programme did so through a reflective process of assessing their current career status and future career values. Participants in this study believed nursing would provide a secure and sustainable career path, potentially creating new horizons or possibilities beyond their previous work and life experiences. Having insight into what motivates individuals to enrol in such programmes may assist both education providers and the health sector with RN graduate recruitment and graduate entry programme enrolment.

The World Health Organisation predicts a global nursing workforce shortage of 5.7 million. To address this shortage the total number of nursing graduates need to increase by 8% per year (WHO, 2020). These predicted workforce shortages are evident in both New Zealand and Australian nursing contexts (Health Workforce Australia, 2014; Health Workforce New Zealand, 2018). Graduate entry nursing (GEN) programmes are well established in the United Kingdom and the United States of America (USA), yet relatively new to the New Zealand and Australian contexts. In New Zealand and Australia, the Master of Nursing Science (MNSc) is a graduate entry programme in which graduates from any discipline complete a Master’s degree over two years full time and on completion, are eligible to become a registered nurse (RN). These programmes have been developed to meet the predicted global shortage and demands of the health workforce and provide graduates an accelerated pathway to becoming an RN. With expanding nursing scopes of practice and associated increased levels of responsibility and autonomy, nursing is an attractive career option for this growing market of graduate entry students.

Graduate entry nursing programmes are known internationally to attract self-motivated, independent, assertive, mature graduates who prefer self-directed learning (Neill, 2012; Pellico et al., 2012). Students attracted to GEN programmes are characterised by their aptitude, academic capacity, determination to succeed (Stacey et al., 2016), and their ability to excel in theory and clinical competence within shorter timeframes (Pellico, et al., 2012; Ziehm et al., 2011). Research to date has largely explored GEN student attributes, capabilities, experiences, and perspectives, such as: “graduateness” (Stacey et al., 2016), resilience and transition (Meyer & Shatto, 2018), learning style preferences (McKenna & Brooks, 2018), how students’ learning experience prepared them for practice (Cangelosi, 2007); and students’ perspectives after completing the GEN programme (Meyer & Shatto, 2018; Neill, 2012).

A review of the published literature found there were just six studies that investigated the motivations to enrol in a GEN programme (DeWitty et al., 2016; Harding et al., 2018; Jamieson et al., 2019; McKenna & Vanderheide, 2012; Neill, 2012; Raines, 2010). These six studies extended from 2011 to 2019 and were conducted in USA, Australia, and New Zealand. In the New Zealand context this paucity of research likely reflects the recent implementation of GEN programmes in 2014. In fact, the only New Zealand study investigated a single sample of eight men (Harding et al., 2018; Jamieson et al., 2019). The literature review identified the key factors that motivated GEN students to commence their programme may be both individualised and context-dependent, suggesting that developing an understanding of these multi-dimensional motivators is complex. The four themes identified were: finding meaning and purpose through altruism and caring, seeking a satisfying career; looking for a change in direction; and reduced financial burden.

In sum, although GEN programmes have existed internationally for many years, there is a paucity of research exploring students’ motivations for enrolling in these programmes. It is timely to undertake this research due to the predicted workforce shortages (WHO, 2020). Exploring students’ motivations for enrolling in the GEN programmes will support the development of existing and future programmes to both suit and support learners needs, whilst meeting academic and regulatory body requirements. Identification of the key motivations for students enrolling in the GEN programmes will inform strategies for promotion and recruitment into programmes, programme development, and future research opportunities. Thus, the aim of this study is to explore the motivations for enrolling in a GEN programme.

Methodology

This study uses a qualitative approach to explore the motivation of students enrolling in the graduate entry MNSc degree in four educational providers. The study used a longitudinal case study design, informed by Yin (2014). Case study research design captures information through using ‘how’, ‘what’, and why’ questions (Yin, 2014, p. 10). In this study, the first phase of data collection aims to explain the motivation of students to enrol in the MNSc degree, while subsequent phases will explore the experiences of students during the programme and after graduation. Case study research design is appropriate for the proposed study because it is suitable for both exploratory and explanatory research, investigating phenomena in context (Yin, 2014).

Case study research may investigate phenomena within a single case, or across multiple cases. One rationale for choosing a single case study design is when the case is unique, as is the proposed study (Yin, 2014). Within single case study research design, embedded units of analysis may be, for example in the proposed study, the cohort of students at each of the four study sites could be considered an embedded unit of analysis (Yin, 2014). However, because of the potentially small number of participants involved, to enhance anonymity, the entire cohort of students was treated as a single case in the proposed study.

Study data was analysed to build an explanation of students’ motivation for enrolling in the MNSc programme and to explore their experiences of studying in the programme. Data analysis involved searching for common patterns, insights and concepts (Yin, 2014). An inductive and deductive, iterative approach of reading, rereading, and discussing the transcripts was used by the research team (Braun & Clarke, 2006, 2013). Operational definitions of the codes and themes were developed in discussion by the research team, contributing to study quality (Yin, 2014).

Methods

The first phase of this study was conducted across four tertiary level education providers in New Zealand and Australia that offer a Graduate Entry MNSc programme.

Objective

To explore the reasoning behind students choosing a graduate entry MNSc degree over a traditional undergraduate nursing programme.

Research Question

The research was guided by the following question asked of the students: “Why did you decide to enrol in and undertake the MNSc nursing programme?” The use of a general question was intentional to keep the research design simple and the impact on the students’ time minimal while eliciting a plethora of data.

Data Collection

All students commencing a MNSc degree at the beginning of 2020 across four education providers (3 New Zealand, 1 Australian) were eligible to take part in the study. All other students were excluded. Students across all education providers were invited simultaneously to participate in the study with invitations posted on the online learning platforms by a non-teaching staff member. Students could contact this person if they wished to participate. Participant information sheets were then forwarded to the self-nominated student and any questions were answered. Participants were given the contact details of the lead researcher at each site and informed that they may withdraw at any time without prejudice to their ongoing study or enrolment. They were also able to request that their data is destroyed (prior to publication of results).

Ten students from four educational institutions consented to participate in the study (2 were from Australia, and the remaining 8 from NZ, across 3 institutions with 4 from one and 2 from each of the others). Seven participants identified as female, two as male, and one as non-binary. The mean age of participants was 30 years (Std. Dev. 8). The youngest participant was 21 years old and the oldest participant was 47 years old. Half of the participants described their ethnicity as New Zealand Pakeha (New Zealander of overseas descent, usually European), two participants described their ethnicity as Indian, two as other, and one as Australian European.

Individual interviews were arranged at a time to suit the student. Informed verbal and written consent were obtained prior to the interview. A researcher from a different university undertook the interviews. This was to ensure confidentiality and impartiality on the part of the research team and as reassurance to the students. Interviews were audio-recorded and transcribed verbatim by an individual external to the research team. All transcripts were de-identified and coded using a unique identifier to maintain anonymity of the participant but also enable subsequent interviews to be assigned to a particular participant.

Thematic analysis was used to analyse the interview data. This was undertaken by three members of the research team independently in the first instance. Following this, the themes arising were discussed between the three researchers followed by a team discussion and collaborative development of the themes. This triangulation of data analysis provides a robust framework from which to present the findings.

Ethical Approvals

Ethical approvals were obtained from Auckland University of Technology Ethics Committee (AUTEC) (19/428) and The University of Melbourne Human Ethics Advisory Group (20,56,175). The AUTEC approval was tabled at the Otago University Human Ethics Committee and the Wintec Human Ethics Research Group (HERG).

Research Reflexivity

The method of recruitment, interview processes, transcription and analysis were underpinned by the research team acknowledging and reflecting on each individual’s positioning as insiders to this research, potentially influencing all stages of the research process. To ensure rigour and transparency, a process of reflexivity (e.g., see Barrett et al., 2020) was embedded in the conduct of this research. This was a continuous process from inception of the research through to presenting the findings. The insider perspective was embraced as a strength of this study. For clarity and transparency, the collaborative research group identified individual assumptions on commencement of the research. Underpinning the collaborative research team’s approach for conducting this research was to be supportive and meaningful to the participants, and of future benefits to the participants as both individuals and a cohort.

Results

The analysis of the interviews revealed three primary themes: why nursing, future planning, and programme design.

Why Nursing?

This theme encompasses the beliefs about the nature and scope of nursing that informed participants ’ choice of nursing as a career. Nursing was perceived as a relational, altruistic and caring profession that would enable them to contribute to society through helping other people. Participants related how they wanted to make a difference or help people, in ways that were meaningful to them.

 … for me, it's pretty much just being a helpful person, like a giving member of the community, somebody that can hopefully make a difference to the health outcomes of people around me … , just that … feeling that I have done something positive and made an impact. Those are my primary motivations. (Participant 10)

The desire to help people, and facilitate access to health care services, was derived from their own experience of observing family members who were ill or in need of care. However, this motivation to make a difference was also articulated at the macro societal level, in ensuring equitable access to healthcare and contribute to reducing health disparities. As one participant put it,

I guess the access to healthcare as well and trying to make sure that it's equitable and … , I think there was a bit of a hard truth, saying that it's not equitable when the fact that I can see a doctor the same day in … whereas it could take me upwards of two or three weeks at home. (Participant 10)

The potential to ‘make a difference’ at the global level by being able to work with minority populations and health services in developing countries was also articulated. The idea of making a difference was derived from participants’ observations of seeing how nursing could change people’s experience of illness or trauma. Participants also understood and recognised the potential of nursing to make a difference in their own lives.

Prior life experiences influenced their understanding that nursing could provide opportunities for self-advancement. They saw nursing as having very real flexibility and multiple potential directions for career development. Participants’ motivations were further influenced by what they cited as missing from their previous work roles.

 … my job was in either an admin or more recently in business development and I wasn't feeling like I was being fulfilled in the way that I'd like to have been was often felt quite underwhelmed by the work that I was doing and didn't feel like I was really contributing the way I would like to. (Participant 9)

Participants explained they entered into their previous study and employment because of family or other societal expectations, but with life experience, they realised they could choose a career that aligned with their personal attributes and values. Sometimes the desire to become a nurse had been present for some time, though subjugated or influenced by other expectations. For example, some parents advised their children not to become nurses.

Yet, there were other parents who were nursing role models, able to work flexibly and manage family responsibilities. Some participants admired their parents whom they perceived as good nurses and capable people.

 … I was like always interested in nursing and my, you know, parents are both nurses, so I was like ooh, like this looks interesting, and it was … (Participant 5)

 … my mother is a nurse … my mother was. working for a voluntary organisation in primary health care and … I saw growing up my mum would work maybe three days a week, night shift, two days, three days, and she still had enough money to … support us as a family. (Participant 2)

 … my mum … she was a nurse, so that probably explains it a little bit. She was a nurse and then a teacher and now she’s a lawyer, so … She’s been quite inspirational for like, you know, you never have to have one career. (Participant 7)

Practising as a nurse was seen as a way of expressing important personal values, as well as affording employment stability, and a challenging career. Participants recognised nursing as flexible, with the potential to grow a career that would enable a rewarding future. Planning for their own futures influenced participants’ decisions to enrol in MNSc programmes.

Future Planning

This theme relates to how participants had devoted significant time and effort into considering their decision to enrol in the MNSc. Some had thought about this for many years, and one shared they had considered the MNSc before their first degree. Others came to realise the career they were currently in did not fit with their values or was not giving them aspects they wanted.

I’ve always thought that nursing would suit my personality and I just thought I have to have a job where I’m working with people constantly. I don’t want to be stuck behind a desk. I love talking to people and hearing from people. And that’s, when I’m supposed to be doing other things, that’s what I end up doing. So, I thought why not make that a career? So yeah, people are a priority so why not do something with it that works. (Participant 7)

Before enrolling in the MNSc programme, participants reflected on how the knowledge and skills gained from their work experience and previous study might contribute to their future nursing career. And yet, they recognised the commitment in time and resources the change in career would involve.

It has also allowed me to piggy back on my past tertiary experiences and not completely ignore them and cross out any knowledge that I have gained from them and just being able to jump into a masters programmes with everything I have got in my backpack is just amazing and yeah it is giving a chance to those who think it was too late and the truth of the matter is that it is never too late. (Participant 4)

Some participants enrolled in the programme to gain a nursing registration to enhance their capability to work in their chosen field. They had thought about how the skills and qualities they might gain would enhance future career possibilities. Once participants had chosen nursing as a career, they then investigated which programme would meet their needs.

Programme Design

This theme encapsulates several influences on participants’ motivation for choosing to enrol in an intensive MNSc rather than a three year bachelor of nursing programme. The reasoning underpinning the choice of a MNSc programme is distinct from the rationale for the decision to pursue a career in nursing. Motivations for choosing the MNSc programme were multifaceted, including the perceived benefits of a shorter, more intense programme with mature student colleagues, being able to staircase previous learning, and the potential for accelerated academic career progression.

Students enrolled in MNSc programmes are generally older and have competing responsibilities, such as family and financial commitments. Having competing responsibilities means that the intensive programme, where students are enrolled for two years instead of the traditional three years for bachelors’ programmes, is financially appealing. Participants perceptions were that taking two years away from the workforce to study is manageable financially.

We have a family, and I focus on study full time, so doing two years instead of doing three years is a bit intimidating. Still, it has undoubtedly made it more appealing because I am putting most of my earning capability on hold for two years. (Participant 3)

The potential for interacting with like-minded peers was another motivator. Participants inferred that Masters’ level study was preferred, as it meant they were able to meet peers with similar life-goals and ambitions, rather than interacting with school leavers who would have different goals and life responsibilities.

I didn’t really want to go into a classroom of undergraduates fresh from high school if I could avoid it. And the idea of like joining a small, diverse group of people who were interested in changing their career or changing their degree seemed really interesting to me. (Participant 7)

Participants had perceptions about how the programme would help them develop further attributes gained from their previous careers by reflecting on, conversations with health professionals who gave insights into the characteristics they saw in these students. One participant identified how these attributes, such as critical thinking, enable them to contribute a unique perspective to the cohort and profession.

When I was talking to Charge Nurses who have had the Master’s students [on clinical placements], they said they take a little bit longer to get cottoned on but they have got very good critical thinking and, they are very good nurses and I liked the sound of that. (Participant 5)

The final motivation in this theme was the perception among participants that the MNSc qualification will equip them to contribute to nursing at a high level. Participants talked about their desire to work in management or policy roles indicating a belief in the potential of the qualification to enable an advanced career path.

I also think accelerates you to more leadership roles in the future. Perhaps later on down the line being involved in more of the policy side of things as well, not just necessarily having a leadership role within a community or a hospital environment, but perhaps going to further and working at a management type role or involved in policy or the politics of nursing or something along those lines. (Participant 9)

The results of this study clearly indicate that participants' motivations for enrolling in a MNSc programme were multi-factorial. They gathered information, in the form of other people’s opinions, personal self-reflection, examined their previous career, and investigated the attributes of nursing programmes. The participants have life experiences and they have considered their future and reflected on what is missing in their career but perhaps also in their lives. They have sought to study nursing because it complements what they already have and opens up new horizons for their future.

Discussion

The findings from this study highlight that students engaging with a graduate entry MNSc programme do so through a reflective process of assessment of their current career status and future career values. A notable driver for these participants in this study was to make a difference in the lives of others through contributing to communities and society, this aligns with the previous works of DeWitty et al. (2016), Harding et al. (2018), McKenna and Vanderheide (2012), Neill (2012) and Raines (2010). Moreover, these participants’ decisions to become a registered nurse are informed by their own personal experiences of healthcare encounters and the need for a more equitable system of access to services, together with a need to be people focused and not confined to ‘desk work’. While previous authors have alluded to the drive of needing a more satisfying career, there is little to support that those participants were basing their decisions on prior experiences. This study therefore, offers further insight into graduate entry MNSc students’ decision-making.

Some participants indicated that their desire to be a registered nurse was a life-long ambition, a point supported by Neill (2012), but in this instance a goal that was previously thwarted through family expectations. While family expectations play a significant role in guiding younger dependants, it appears that this intensive programme provides a realistic means to achieve that previously held goal. Perhaps, however, it is the ongoing image of nursing that is problematic for families to accept, in that nursing remains a gender divided, low paid profession in comparison to similar medical roles (Clayton-Hathway et al., 2020) and they do not wish their family to pursue this pathway. Yet, this is contrasted with other family members, who are registered nurses and present as excellent role models in terms of both career pathway and the ability to engage with flexible work patterns to meet the needs of growing families. The latter point being supported by DeWitty et al (2016) and McKenna and Vanderheide (2012).

In keeping with previous literature (DeWitty et al., 2016; Harding et al., 2018), these participants indicated that the MNSc programme was attractive due to the shortened timeframe of study, as well as being financially appealing. However, it was also notable that studying alongside likeminded peers with similar goals was a draw of the MNSc programme, as was the desire to become a critical thinker; the latter of which they considered to be essential in being better equipped for the nursing workforce. While these points fit in with previous literature on resilience and perhaps learning styles (McKenna & Brooks, 2018; Meyer & Shatto, 2018), these findings elaborate on these points demonstrating a greater depth of thought and consideration in applying for and completing a MNSc qualification.

While this study has considered graduate entry MNSc students from both New Zealand and Australia, the findings are likely to be transferable to other Western countries in terms of students’ motivations for undertaking these intensive programmes. Specifically, the idea of wanting to care for and serve communities. Although GEN providers have been aware of the underlying needs of this student cohort, this study presents a more detailed narrative of the reflective rationales for engaging with this learning beyond merely a speedy means to a useful qualification. It offers insight into the deep thinking already at play in the minds of this student cohort prior to undertaking study which should, in turn, provide astute, thoughtful, and reflective practitioners on completion of their studies and subsequent shift into practice to engage with communities.

This study offers a robust insight into the motivations of graduate entry MNSc students through the multi-site participation of MNSc programme providers, in more than one country. Indeed, the participants represent different cities throughout New Zealand and one in Australia, each with unique population demographics, thus the results draw from a variety of perspectives. Furthermore, data collection was facilitated by staff from education providers participating in the research, to reduce the risk of coercion on participants, with the data analysis being triangulated across all researchers in stages. The results appear to provide a consensus across all education providers in relation to the motivations expressed by students and their desire to undertake a graduate entry MNSc programme. While this research was focused on a single phenomenon, which was students’ motivations, it provides a stepping off point for further research. The findings of this research will influence the development of the questions for the next phase of the research that will explore students’ experience of this programme of study.

Conclusion

This study explored students’ motivations for choosing to enrol in an intensive MNSc programme. The findings show that these motivations were well considered and multifaceted, including the influence of nursing role models. Participants in this study believed nursing would provide a secure and sustainable career path, potentially creating new horizons or possibilities beyond their previous work and life experiences. They perceived nursing as an attractive profession which enables them to contribute in meaningful ways to their communities, enhance their own career prospects, while building on attributes gained from their previous careers, such as critical thinking. Flexible work roles and a range of employment opportunities as registered nurse graduates was part of this attraction. The two-year intensive MNSc programme required students to take less time out of paid employment to complete the programme and enabled them to learn with likeminded people in their student cohort. In the current environment with nursing shortages globally and in Australasia it is important to explore alternative pathways into the profession. Having insight into what motivates individuals to enrol in a graduate entry MNSc programmes may assist both education providers and the Health Sector with RN graduate recruitment, graduate entry programme enrolments, and programme design.

ORCID iDs

Andrea E. Donaldson https://orcid.org/0000-0002-8548-4221

Virginia Jones https://orcid.org/0000-0003-0267-057X