Content of this journal is licensed under a Abstract
AIM
The aim of this study is to define the plans for professional work in the field of nursing, of nursing students in their senior year of post-graduation studies, and the factors affecting them.
Method
This descriptive study included 2818 senior nursing students from 27 schools of nursing from different geographical regions of Turkey. The Questionnaire for Career Planning and Affecting Factors was used to collect the data.
Results
Most of the students (59.2%) see themselves as nurses in the next five years, and 31.7% of them see themselves as academicians in the next ten years. The rate of students who wish to work in a non-nursing profession within the next five years is 2.3%. Geriatric services were the least preferred.
Conclusion
Most students stated that they wanted to work as a nurse. The elder-care centers should be made attractive options for new graduate nurses to choose to work there.
Keywords: Career plans, Generation Y, nursing students
Introduction
The recent changes in culture, health, national politics, and privatization, along with significant generational differences has led to changes in the career choices of nurses. Studies suggest that previously, the nursing profession was chosen for philanthropic and altruistic reasons, whereas the youth, today choose nursing and its related fields mostly based on the criteria of increased employment and better pay (Chung & Fitzsimons, 2013; Jamieson et al., 2015; Toren et al., 2012).
Currently, efforts are being made to organize both the teaching and working environment in all areas of employment based on generational differences. It is important that we know about the plans of Generation Y after graduation, the places they prefer to work, and what factors affect their preferences, so that the work force and the future of educational programs can be set up (Chung & Fitzsimons, 2013; Lavoie-Tremblay et al., 2010). Yet, we know that information in the literature on the areas of work for nursing students after graduation is not consistent at all (Shoqirat & Abu-Qamar, 2015). Although many educators state that the students wish to work in easier areas and mention the generational differences, there are limited studies on the characteristics of Generation Y and the effects of these characteristics on choices regarding the field of work (Freeman et al., 2012; Lee & Moon, 2013; Shoqirat & Abu-Qamar, 2015; Silvestri et al., 2014), and those studies mostly focus on reasons for decisions to quit the job (Lavoie-Tremblay et al., 2011; Rhéaume et al., 2011; Rudman et al., 2014; Wieck et al., 2010).
In Turkey, there are not many studies conducted in this field. It is important to review the nursing curricula in line with the needs and preferences of the Generation Y nursing students, to make changes and to develop strategies that will provide realistic guidance for the career plans of this generation in the clinical field, so that the turnover rates can be lowered, and the quality of care can be improved (Chung & Fitzsimons, 2013). The World Health Organization (WHO) states that in the year 2030, there will be a shortfall of nine million nurses. Considering this statement, it is essential to design work conditions that will respond to the expectations of future nurses and keep them in their profession. Hospitals and other employers can benefit from the results of this research, to attract the new generation of nursing students to their institutions and keep them there. Today’s Generation Y graduates will be the key factor in changes in the future of nursing. Additionally, they will be the future mentors, advisors, and managers of Generation Z nurses, in the years to come. Predicting the preferences of this generation, along with the factors affecting them, is crucial not only for the drawing up of future road maps at a national level but also at an international level.
The importance of selecting the right field in nursing is becoming more and more important nowadays, because of the nursing shortage. The attrition and turnover rate of nurses and especially of the new graduates currently seem to be rather high (Chambers, 2010; Rhéaume et al., 2011; Rudman et al., 2014). Frequent turnovers lead to negative consequences for both the nurses and their employers, and negatively affect the quality of care. Thus, it is of paramount importance to facilitate the integration of new graduate nurses into the workforce, both to lessen the shortage of nurses and to sustain the quality of nursing services (Hayes et al., 2012). Administrators should know the characteristics of the generation that each of their employees belongs to and how these characteristics reflect in their attitude toward work. Literature shows that there are many factors affecting field selection (McCann et al., 2010; Radford et al., 2012). These factors can be categorized into two groups, personal and institutional (Chung & Fitzsimons, 2013; Jamieson et al., 2015; Lavoie-Tremblay et al., 2010).
The personal characteristics of the new generation of nurses have an impact on their plans after graduation. The nursing educators and administrators need to prepare themselves for the Generation Y nurses and the upcoming Generation Z. Generation Y are devoted to their personal liberty and wish to be independent from their families. They do not want to live just to save money and wealth but wish to have a work–life balance. That is why they change jobs frequently, to become an executive or to start their own business. The job switches and search for career development are the definitive qualities of Generation Y, setting them apart from other generations (Chambers, 2010; Kropp, 2012; Radford et al., 2012). From that perspective, working two years in a department is considered a long time for Generation Y nurses. They consider switching to another institution if they are not promoted after working for five years in a workplace, and move to where they believe they can get a faster promotion.
Self-actualization opportunities are especially important for Generation Y. Therefore, career development possibilities, promotion opportunities, research opportunities, and training support (master’s, doctorate, congresses etc.) offered by an institution are influential factors in selecting the institution they will work for (Chambers, 2010; Lavoie-Tremblay et al., 2010). Moreover, the studies on nursing students show that the internship experiences, perception of friends and families, and their own perceptions about their career affect their career selection (McCann et al., 2010; Shoqirat & Abu-Qamar, 2015).
Along with personal characteristics, institutional factors also impact the plans of the new generation of students. Studies show that workload, patient–nurse ratio, job descriptions for nurses within the institution, and job security in the workplace have a significant impact on the workplace selection for new graduate nurses (Lavoie-Tremblay et al., 2010). The hours of work, flexible working hours with more free time, having fewer days of duty, and part-time work opportunities are among the preferred factors that impact workplace selection, in addition to the conditions of the physical environment and easy commute to work. Research has shown that economic conditions are also one of the important factors affecting the preferences of new graduates. Besides, the relationship among the team members within the institution, social support, positive feedback, and supportive attitude are among the impacting factors (Lavoie-Tremblay et al., 2011).
Generation Y make up around 35% of Turkey’s population. Today, most working nurses in Turkey belong to Generation Y, working under the leadership of Generation X. Turkey also faces severe challenges of nursing shortages. Based on OECD 2017 statistics, Turkey is at the fourth position from the bottom of the list, and the number of nurses per 1000 people is 2.1 (Organisation for Economic Cooperation and Development, 2017). The joint report of the Ministry of Health states that as of 2018, there are about 190,000 nurses active in the workforce, and the number of healthcare professionals, including the nurses, is insufficient (Republic of Turkey Ministry of Health, 2018). The studies conducted on job turnover showed rates between 42% and 66% in Turkey (Bezirci, 2012; Caliskan & Ergun, 2012; İleri, 2007; Mert Haydari et al., 2016). Yet, there are a limited number of studies about the preferences of Generation Y graduates and the factors affecting them (Lavoie-Tremblay et al. 2011; Shoqirat & Abu-Qamar, 2015). This study aimed to define the working plans for Generation Y after graduation and the affecting factors.
Research Questions
The research questions of this study are:
What are the senior nursing students’ employment plans after graduation?
What are the factors affecting senior nursing students’ employment plans after graduation?
Method
Study Design
This is a descriptive study.
Sample
There are 106 programs in Turkey offering a bachelor’s degree, as of the 2018–2019 academic year; and the number of students for 2019 is 60,103 (Council of Higher Education, 2019). The schools who consented to take part in the research (20% of current programs) and from different geographical regions of Turkey are included in the study. Four of the schools are private and the others are public universities. The sample set included 2818 senior nursing students The final year undergraduate nursing students were selected for this study because they were considering various employment choices but had not yet made final decisions.
Data Collection
The “Student Information Form” (10 Questions) and “Questionnaire for Career Planning and Affecting Factors” (15 Questions) designed by the researchers in the light of the current literature, were used to collect the data (McCann et al., 2010; Radford et al., 2012; Shoqirat & Abu-Qamar, 2015). The form includes questions designed to elicit the career preferences of the students, along with the factors affecting them.
The data were collected by volunteer faculty in each school. The students were given information about the research by faculty in every school. The students who accepted to participate in the study were asked to fill out questionnaires, after obtaining their consent. Collection of data took 20–25 minutes.
Statistical Analysis
Version 21.0 of Statistical Package for the Social Sciences (IBM SPSS Corp., Armonk, NY, USA) for Windows program was used for analysis of data. Numeric and percentile distributions were used for data regarding the sociodemographic characteristics of the students, and t-test and chi-square test are used for comparisons.
Ethical Considerations
Before starting the study, written permissions were obtained from Koç University Ethics Committee (Date and Decision Number: 16 June 2017; 2017.071.IRB3.039). After ethical approval, a contact faculty member in each school of nursing was chosen and the questionnaires were delivered to the students via that contact person. The data were collected between January 2019 and June 2019.
Results
Table 1 shows the personal characteristics of the students. Most of the students were female (76.9%), and 47.2% of them had entered nursing school as their first choice in the university exams and held an average academic success score of 2.85 ± .43.
Table 1.
Personal Characteristics of the Students (N = 2818)
| Characteristics | Frequency (%) |
|---|---|
| Gender | |
| Female | 2167 (76.9) |
| Male | 651 (23.1) |
| Preference ranking order of nursing | |
| 1 | 1329 (47.2) |
| 2–5 | 665 (23.6) |
| 6–10 | 227 (8.1) |
| 11 and more | 258 (9.2) |
| Mother’s education level | |
| Primary school | 1790 (63.5) |
| Secondary and high school | 772 (27.4) |
| University | 123 (4.4) |
| Father’s education level | |
| Primary school | 1225 (43.5) |
| Secondary and high School | 1161 (41.2) |
| University | 401 (14.2) |
| Total | 2818 (100) |
| University preference ranking average | 3.99 ± 5.53 (1–30) |
| Grade point average (GPA) | 2.85 ± 0.43 |
Note: *The number of “unanswered participants” has not been shown in the table.
Most of the students (72.7%) want to work as a nurse after graduation and 13.0% of them want to work in a field other than nursing; 39% of the students want to work in the clinical field and 34.1% of them as academicians. After graduation, the students want to work in the operating room (32.6%), and the acute care units (30.4%) (Table 2).
Table 2.
Students’ Future Plans of Work (N = 2818)
| Post-graduation career plan | Frequency (%) |
|---|---|
| Working as a nurse | 2036 (72.7) |
| Working, but not as a nurse | 363 (13.0) |
| Not working | 45 (1.6) |
| The field of nursing preferred | |
| Bedside nurse/clinical nurse | 1108 (39.6) |
| Academician in the university | 954 (34.1) |
| Nurse manager | 577 (20.6) |
| Nurse in community mental health | 567 (20.2) |
| The position | |
| Clinical/bedside nurse | 1027 (36.7) |
| Education nurse | 845 (30.2) |
| Chief nurse | 654 (23.4) |
| Supervisor | 340 (12.1) |
| Nurse administrator | 353 (12.6) |
| The unit type | |
| Operating room | 909 (32.6) |
| Acute care | 848 (30.4) |
| Family medicine center | 814 (29.2) |
| Psychiatry | 523 (18.8) |
| Pediatric | 387 (13.9) |
| Workplace | 235 (8.4) |
| Oncology | 226 (8.1) |
| Health tourism | 159 (5.7) |
| Nursing home/rehabilitation center | 158 (5.7) |
| Pharmaceutical company | 119 (4.3) |
| Palliative care | 99 (3.6) |
| Home care/private care agencies | 98 (3.5) |
| Geriatrics | 76 (2.7) |
Note: *All the variables were multiple answers in the table and they were counted by using the multiple answers method.
Most of the students (59.2%) see themselves as nurses in the next five years, and 31.7% of them see themselves as academicians in the next ten years. The rate of students who wish to work in a non-nursing profession within the next five years is 2.3%, and 6.8% for within the next ten years (Table 3).
Table 3.
Five and Ten Years Post-Graduation Projections of Students (N = 2818)
| Positions | Frequency (%) | Frequency (%) |
|---|---|---|
| Five Years Later | Ten Years Later | |
| Nurse | 1668 (59.2) | 19 (0.7) |
| Academician | 315 (11.2) | 892 (31.7) |
| Nurse manager | 336 (11.9) | 566 (20.1) |
| Work other than nursing | 65 (2.3) | 193 (6.8) |
| Having private care agency | 32 (1.1) | 72 (2.6) |
| Working abroad (US, Europe) | 134 (4.8) | 358 (12.7) |
The top five factors influencing the work field preferences of students are as follows: A supportive approach toward a Master’s program and professional development (86.1%), career development opportunities and promotions (85.3%), research opportunities (80.9%), being able to see different types of cases (80%), and high salaries (79.8%) (Table 4).
Table 4.
The Factors İnfluencing the Field Preferences of Students (N = 2818)
| Factors | Positive Influence, n (%) | No Influence, n (%) | Negative Influence, n (%) |
|---|---|---|---|
| Supportive attitude, professional development | 2405 (85.3) | 330 (11.7) | 50 (1.8) |
| Career development opportunity and promotion | 2281 (80.9) | 423 (15) | 64 (2.3) |
| Research opportunity | 2254 (80) | 407 (14.4) | 100 (3.5) |
| Variety of cases | 2249 (79.8) | 424 (15) | 107 (3.8) |
| High salary | 2187 (77.6) | 383 (13.6) | 193 (6.8) |
| Job security | 2064 (73.2) | 605 (21.5) | 96 (3.4) |
| Social activities offered by the institution | 1928 (68.4) | 589 (20.9) | 227 (8.1) |
| Attitude of the instructor | 1927 (68.4) | 587 (20.8) | 255 (9) |
| Opportunity to work autonomously | 1888 (67.0) | 754 (26.8) | 113 (4) |
| Instructor’s/nurses’ advice | 1848 (65.5) | 609 (21.6) | 288 (10.2) |
| Attitudes of patients and families | 1715 (60.9) | 567 (20.1) | 472 (16.7) |
| Flexibility of working hours | 1664 (59.0) | 547 (19.4) | 556 (19.7) |
| Number of nurses (patient–nurse ratio) |
Note: *Cronbach’s α coefficient of the form was .912.
Discussion
This study examined the senior year nursing students’ (n = 2818) preferences after graduation and the factors affecting them. Most of the students planned to progress within the nursing profession and projected themselves in administrative and academic posts in 5–10 years. They preferred mostly to work in the operating room, acute care units, family health centers, and psychiatry and pediatrics departments.
In this study, most students stated that they wanted to work as a nurse. Another statistic which supports this finding, is the low rate of students who want to work in non-nursing jobs, when asked about where they see themselves in ten years’ time. The students plan to still be an academician or an executive/administrative in nursing within their ten-year forecast. Contrary to the findings of this study, the literature underscores that the rate of new graduate nurses working in clinics keeps dropping and that they are more willing to work in non-nursing jobs, quoting difficulty in facing the reality of work life and their inability to cope with job stress as their reasons (Duffield et al., 2004; Huang, 2004). One of the issues in the Shoqirat and Abu-Qamar (2015) study is the uncertainty that the students feel about after graduation. Contrary to this report, the inclination to work as a bedside nurse and to develop a career plan in nursing emerged in this study.
Turkey started to implement internship programs in the senior grade to facilitate coping with the “shock of reality” mentioned in the literature. Internship covers two terms in some schools, whereas it is only one term in some others (Ateş et al., 2017; Tosun et al., 2008). This amendment might have made it easy for the students to adapt to the clinical environment. The students might be feeling that they are more prepared for what is expected of them. On the other hand, despite the high rate of unemployment among youth, with the unemployment rate (TUIK 27.1%) in Turkey, nursing is one of the professions that is relatively easier to be recruited into. That might be the reason why the new graduates prefer to work in this field. Moreover, even though not proportional to the difficulty of the nursing profession, the relatively higher income compared to many other professions in Turkey might influence this result. Considering that the Generation Y nurses attach much importance to job security and high salaries, this result does not come as a surprise at all.
One other important result of this study shows that the rate of students wishing to be an academician is low for the early years, but increases for the period after ten years. This finding overlaps with the self-realization motive of Generation Y. This is because when asked about the factors affecting their career preferences, this group responded with answers such as career development opportunities, supportive training approach, and research opportunities, which are all about self-realization. Similarly, literature also states that having appropriate support for their career development is important to them (Lavoie-Tremblay et al., 2010; Liu et al., 2019). Generation Y members assess the work environment as either enriching or a hindrance to their professional development. Huang (2004) similarly showed that the majority of the students prefer to work as nurses whereas some wish to be academicians.
Complying with the literature (Balyacı & Özsoy, 2011; Radford et al., 2012), it is seen that the major factors affecting the choice of the preferred field of work are supportive attitude toward training, career development, and research opportunities. In addition, high salaries, job security, and flexible working hours are among the most affective factors, seen in this study. In some other studies supporting our finding, high salary was found an important factor (Balyacı & Özsoy, 2011; Koc et al., 2014; Liu et al., 2019).
Almost half of the students stated that the attitude of clinical instructors and nurses make a positive impact on their preference. This finding may be justified with Generation Y’s need for receiving mentoring and feedback. The guidance of their instructors can be influential in their choices. However, it is a concern for the profession that many of the respondents expressed their negative views about the lack of personal support in the workplace (Jamieson et al., 2015).
Nurses have an intention to migrate overseas to developing countries. There seem to be three major motivations for this; first, the increase in health tourism, second, the aging population in developed countries and the demand due to the lack of nurses, and third, economic hardships (Lee & Moon, 2013; Palese et al., 2017). In this study, when compared with other studies, showed that even after ten years, the rate of nurses intending to go overseas is lower. The reasons for not considering this alternative might be due to the relatively better salaries and easy employment here, and the language barrier can be another factor hindering this choice. The literature also shows that there are quite a few different pieces of information regarding the preferred areas of work of nurses (Matarese et al., 2019). This study points out that students mostly prefer the operating room, acute care units, family health centers, psychiatry, and pediatrics departments to work after graduation. Similar to this study, some studies also present that acute care centers as well as medical surgical clinics are the top choices (McCann et al., 2010, Shoqirat & Abu-Qamar, 2015). In this study, geriatrics, palliative care, oncology, and home care centers are the least preferred areas, which are also compliant with the literature (Haron et al., 2013; Hoekstra et al., 2010; Neville et al., 2014; Robinson et al., 2008; Shen & Xiao, 2012). The establishment of palliative care centers and home care services are rather new in Turkey, where the geriatric services are limited to nursing/rest homes having a small number of nurses working at these facilities. That might be why the students do not see these relatively new fields as favorable for self-actualization. Yet, it would be beneficial to study in detail the reasons for new generation nurses not wanting to work with the elderly, especially in a culture that emphasizes respecting the elderly, along with an already aging population. Home care nursing is given as the next least favored field of work. One other reason for these fields being much less preferred might be due to the students lacking sufficient clinical experience in these areas and not having role models.
Study Limitations
The generalizability of the study results is compromised by the facts that the participating number of institutions is relatively small, and it is conducted in one country only. One limitation is that the reasons for the choice of areas in which the students want to work in the future were not analyzed in depth. Another limitation is that there were no analyses of the reasons for students to choose the field they want to work in, in the future.
Conclusion and Recommendations
This study, designed to define the work field preferences of senior year nursing students and the factors affecting professional preferences after graduation, concluded that these Generation Y students prefer hospitals as the workplace, most of them do not consider leaving, and they consider factors regarding career development.
This study determined that the instructors and the clinics where they obtain their clinical education have a huge influence on career choice. That is why it is suggested that they are supported to participate in teamwork in the clinics during their internship. Organizing meetings with nurses, sharing the research results, and enabling nurses to interact with students and to mentor them, knowing their influence as a role model in their professional choices.
It is identified that the nursing students do not want to work with the elderly. This is an outcome that needs to be further examined regarding the ever-aging population, which has become a global priority. This calls for revising the public health practices and transforming the nursing home institutions into appealing workplaces to attract the new graduates. It can be suggested that the structural qualities of these types of institutions can be reassessed and improved, such as flexible working hours, career development, and self-actualization, which are important for the new graduate nurses.
Generation Y students stated that having appropriate support for their career development is important to them. Considering these results, the nurse managers need to plan initiatives toward self-actualization so that they can specifically attract new graduates toward their institutions and benefit from their potential at the utmost possible level. The nurse managers should support the new graduates to attend congresses, courses, and educational endeavors such as a Master’s degree. Half of the students stated that the attitude of nurses makes a positive impact on their preference. Therefore, nurse managers should provide a positive internship environment and a good mentorship when intern students come to their clinics for internship.
Ethics Committee Approval
The ethical approval from Koç University Social Sciences Ethics Board (Date: May 10, 2020, 2020.205.IRB3.085).
Informed Consent
Written informed consent was obtained from all participants who participated in this study.
Author Contributions
Concept – A.A., F.O., A.K., A.F.O., A.İ.A.; Design – A.A., F.O., A.K., A.F.O., A.İ.A.; Supervision – A.A., F.O., A.K., A.F.O., A.İ.A.; Resources – A.A., F.O., A.K., A.F.O., A.İ.A.; Materials – A.A., F.O., A.K., A.F.O., A.İ.A.; Data Collection and/or Processing – A.A., F.O., A.K., A.F.O., A.İ.A.; Analysis and/or Interpretation – A.A., F.O., A.K., A.F.O., A.İ.A.; Literature Search – A.A., F.O., A.K., A.F.O., A.İ.A.; Writing Manuscript – A.A., F.O., A.K., A.F.O., A.İ.A.; Critical Review – A.A., F.O., A.K., A.F.O., A.İ.A.
Funding Statement
The authors declared that this study has received no financial support.
Footnotes
Peer Review: Externally peer-reviewed.
Conflict of Interest: The authors have no conflicts of interest to declare.
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