Untested changes in nursing education in Australia, such as the introduction of double degrees in nursing, necessitate a new research approach to study nursing career pathways. A review of the literature on past and present career choice theories demonstrates these are inadequate to gain an understanding of contemporary nursing students’ career choices. With the present worldwide shortage of nurses, an understanding of career choice becomes a critical component of recruitment and retention strategies. The purpose of this paper is to demonstrate how an ecological system approach based on Bronfenbrenner’s theory of human development can be used to understand and examine the influences affecting nursing students’ and graduates’ career development and career choices. Bronfenbrenner’s socioecological model was adapted to propose a new Nursing Career Development Framework as a way of conceptualizing the career development of nursing students undertaking traditional bachelor of nursing and nontraditional double-degree nursing programs. This Framework is then applied to a study of undergraduate nurses’ career decision making, using a sequential explanatory mixed method study. The paper demonstrates the relevance of this approach for addressing challenges associated with nursing recruitment, education, and career choice. 1. Introduction The overall effectiveness of any healthcare system depends on a viable nursing workforce to provide optimum population health outcomes [1]. Yet that viability is under increasing threat as the recruitment and retention of nurses both in Australia and overseas reaches a crisis point [2–4]. At the time of writing, estimated shortages in Australia stand at approximately 10,000 registered nurses [5]. Furthermore, research from several comparable western countries has shown that between 30% and 61% of new graduates intend to leave nursing within their first year [6, 7]. Supply of new graduates from university bachelor of nursing (BN) programs is not able to keep up with demand [8, 9]. In 2002, in an attempt to address this problem, the Australian Federal Government increased the number of funded places for nurse education in universities [10, 11]. Many of these places became situated in new double-degree programs that combine a bachelor of nursing (BN) with another undergraduate degree. Double degrees (DDs), also known as joint, dual, or combined degrees are well established in Australia [12–14] and are slowly on the rise in Europe [15]. These DDs involving nursing are studied conjointly and can be either within a similar discipline
References
[1]
International Council of Nurses (ICN), “The global shortage of registered nurses: an overview of issues and actions,” International Council of Nurses (ICN), Geneva, Switzerland, 2004, http://www.icn.ch/images/stories/documents/publications/GNRI/The_Global_Nursing_Shortage-Priority_Areas_for_Intervention.pdf.
[2]
D. Hegney, A. McCarthy, C. Rogers-Clark, and D. Gorman, “Why nurses are resigning from rural and remote Queensland health facilities,” Collegian, vol. 9, no. 2, pp. 33–39, 2002.
[3]
J. Buchan and L. Calman, “The global shortage of registered nurses: an overview of issues and actions,” Report on Global Nursing Workforce, International Council of Nurses, Geneva, Switzerland, 2004, http://www.icn.ch/images/stories/documents/publications/GNRI/Global_Shortage_of_Registered_Nurses_Executive_summary.pdf.
[4]
J. Buchan and L. Aiken, “Solving nursing shortages: a common priority,” Journal of Clinical Nursing, vol. 17, no. 24, pp. 3262–3268, 2008.
[5]
Australian Institute of Health and Welfare, (AIHW), “National Health and Labour Force Series Number 43,” Nursing and Midwifery Labour Force, 2010, http://www.aihw.gov.au/publications/hwl/hwl-44-10724/hwl-44-10724.pdf.
[6]
L. H. Aiken, S. P. Clarke, D. M. Sloane et al., “Nurses' reports on hospital care in five countries,” Health Affairs, vol. 20, no. 3, pp. 43–53, 2001.
[7]
J. E. B. Duchscher and L. Cowin, “Multigenerational nurses in the workplace,” Journal of Nursing Administration, vol. 34, no. 11, pp. 493–501, 2004.
[8]
R. J. Erickson and W. J. C. Grove, “Why emotions matter: age, agitation, and burnout among registered nurses,” The Online Journal of Issues in Nursing, vol. 13, no. 1, 2008.
[9]
B. Preston, “The Australian nurse and midwifery workforce: issues, developments and the future,” Collegian, vol. 16, no. 1, pp. 25–34, 2009.
[10]
V. Drury, K. Francis, and Y. Chapman, “Where have all the young ones gone: implications for the nursing workforce,” The Online Journal of Issues in Nursing, vol. 14, no. 1, 2008.
[11]
N. Hickey, J. Sumsion, and L. Harrison, “Nursing double degrees: a higher education initiative in times of nursing shortages,” Australian Journal of Advanced Nursing, vol. 28, no. 1, pp. 52–59, 2010.
[12]
C. McInnis, “Signs of disengagement? The changing undergraduate experience in Australian Universities,” Inaugural Professorial Lecture, Centre for the Study of Higher Education, Faculty of Education, University of Melbourne, Melbourne, Australia, 2001.
[13]
C. Batson, R. Sharp, E. Ramsay, and A. Mackinnon, “Combined courses of study: equity group access and participation at the bachelor (honours/pass) level,” Tech. Rep. EIP 01/11, Higher Education Division, DEST, Commonwealth of Australia, Canberra, Australia, 2002, http://www.dest.gov.au/archive/highered/eippubs/eip01_11/default.htm#contents.
[14]
A. W. Russell, S. Dolnicar, and M. Ayoub, “Double degrees: double the trouble or twice the return?” Higher Education, vol. 55, no. 5, pp. 575–591, 2008.
[15]
A. Sursock and H. Smidt, “Trends 2010: a decade of change in European higher education,” Report of European University Association, Brussels, Belgium, 2010, http://www.auqa.edu.au/files/publications/auqf2007_proceedings_final_website_text.pdf.
[16]
J. Hemsley-Brown and N. H. Foskett, “Career desirability: young people's perceptions of nursing as a career,” Journal of Advanced Nursing, vol. 29, no. 6, pp. 1342–1350, 1999.
[17]
L. Gaynor, T. Gallasch, E. Yorkston, S. Stewart, and C. Turner, “Where do all the undergraduate and new graduate nurses go and why? A search for empirical research evidence,” Australian Journal of Advanced Nursing, vol. 24, no. 2, pp. 26–32, 2006.
[18]
S. Price, “Future directions for career choice research in nursing: a discussion paper,” International Journal of Nursing Studies, vol. 46, no. 2, pp. 268–276, 2009.
[19]
I. Fagerberg, B. Winblad, and S. L. Ekman, “Influencing aspects in nursing education on Swedish nursing students' choices of first work area as graduated nurses,” Journal of Nursing Education, vol. 39, no. 5, pp. 211–218, 2000.
[20]
T. V. McCann, E. Clark, and S. Lu, “Bachelor of Nursing students career choices: a three-year longitudinal study,” Nurse Education Today, vol. 30, no. 1, pp. 31–36, 2010.
[21]
M. T. Brown, “The career development influence of family of origin: considerations of race/ethnic group membership and class,” Counseling Psychologist, vol. 32, no. 4, pp. 587–633, 2004.
[22]
S. C. Whiston and B. K. Keller, “Expanding research concerning family influences on career development: cultivating a number of brown spots,” Counseling Psychologist, vol. 32, no. 4, pp. 612–634, 2004.
[23]
C. McInnes and R. Hartley, “Managing study and work, The impact of full-time study and paid work on the undergraduate experience in Australian Universities,” Commonwealth of Australian DEST Report 6824, 2002, HERC02A.
[24]
R. A. Robinson, Pathways in context: background characteristics and demographics in student progression through higher education [Ph.D. thesis], University of Sydney, Sydney, Australia, 2005.
[25]
R. A. Robinson and L. J. Bornholt, “Pathways theory of progression through higher education,” Australian Journal of Educational and Developmental Psychology, vol. 7, pp. 49–62, 2007.
[26]
Royal College of Nursing United Kingdom (RCN), Past Trends, Future Imperfect? A Review of the UK Nursing Labour Market in 2004/2005, 2005, http://www.ren.org.uk.
[27]
L. Gaynor, T. Gallasch, E. Yorkston et al., “The future nursing workforce in Australia: baseline data for a prospective study of the profile, attrition rates and graduate outcomes in a contemporary cohort of undergraduates,” Australian Journal of Advanced Nursing, vol. 25, no. 2, pp. 11–20, 2007.
[28]
U. Bronfenbrenner, The Ecology of Human Development: Experiments by Nature and Design, Harvard University Press, Cambridge, UK, 1979.
[29]
U. Bronfenbrenner, “Six theories of child development: revised formulations and current issues,” in Ecological Systems Theory, R. Vasta, Ed., pp. 187–249, Jessica Kingsley, London, UK, 1992.
[30]
W. Patton and M. McMahon, Career Development and Systems Theory, Brooks/Cole, Pacific Grove, Calif, USA, 2nd edition, 2006.
[31]
P. D. Larsen, J. S. McGill, and S. J. Palmer, “Factors influencing career decisions: perspectives of nursing students in three types of programs,” Journal of Nursing Education, vol. 42, no. 4, pp. 168–173, 2003.
[32]
M. Mooney, M. Glacken, and F. O'Brien, “Choosing nursing as a career: a qualitative study,” Nurse Education Today, vol. 28, no. 3, pp. 385–392, 2008.
[33]
P. McIlveen and W. Patton, “A critical reflection on career development,” International Journal for Educational and Vocational Guidance, vol. 6, no. 1, pp. 15–27, 2006.
[34]
M. T. Brown, J. L. Lum, and K. Voyle, “Roe revisited: a call for the reappraisal of the theory of personality development and career choice,” Journal of Vocational Behavior, vol. 51, no. 2, pp. 283–294, 1997.
[35]
S. H. Osipow, “Roe revisited: why?” Journal of Vocational Behavior, vol. 51, no. 2, pp. 306–309, 1997.
[36]
P. J. Hartung, E. J. Porfeli, and F. W. Vondracek, “Child vocational development: a review and reconsideration,” Journal of Vocational Behavior, vol. 66, no. 3, pp. 385–419, 2005.
[37]
A. Roe, The Psychology of Occupations, John Wiley & Sons, New York, NY, USA, 1956.
[38]
E. Ginzberg, S. W. Ginsburg, S. Axelrad, and J. L. Herma, Occupational Choice: An Approach to a General Theory, Columbia University Press, New York, NY, USA, 1951.
[39]
J. L. Holland, “A theory of vocational choice,” Journal of Counseling Psychology, vol. 6, no. 1, pp. 35–45, 1959.
[40]
R. W. Lent, S. D. Brown, and G. Hackett, “Toward a unifying social cognitive theory of career and academic interest, choice, and performance,” Journal of Vocational Behavior, vol. 45, no. 1, pp. 79–122, 1994.
[41]
D. Ohler and E. Levinson, “Assessment of career maturity in transdisciplinary vocational assessment,” ERIC Document ED 371 279, 1994.
[42]
P. A. Creed and W. Patton, “The development and validation of a short form of the Australian Version of the Career Inventory,” Australian Journal of Guidance and Counselling, vol. 14, no. 2, pp. 125–138, 2004.
[43]
L. S. Gottfredson, “Circumscription and compromise: a developmental theory of occupational aspirations,” Journal of Counseling Psychology, vol. 28, no. 6, pp. 545–579, 1981.
[44]
L. S. Gottfredson, “Gottfredson's theory of circumscription and compromise,” in Career Choice and Development, D. Brown and L. Brooks, Eds., pp. 20–31, Jossey-Bass, San Francisco, Calif, USA, 1996.
[45]
F. Meijers, “Career learning in a changing world: the role of emotions,” International Journal for the Advancement of Counselling, vol. 24, no. 3, pp. 149–167, 2002.
[46]
S. Boughn, “Why women and men choose nursing,” Nursing and Health Care Perspectives, vol. 22, no. 1, pp. 14–19, 2001.
[47]
J. M. Newton, C. M. Kelly, A. K. Kremser, B. Jolly, and S. Billett, “The motivations to nurse: an exploration of factors amongst undergraduate students, registered nurses and nurse managers,” Journal of Nursing Management, vol. 17, no. 3, pp. 392–400, 2009.
[48]
S. M. Crow, S. A. Smith, and S. J. Hartman, “Attrition in nursing: perspectives from the national survey of college graduates,” The Health Care Manager, vol. 24, no. 4, pp. 336–346, 2005.
[49]
W. R. Waugaman and D. J. Lohrer, “From nurse to nurse anesthetist: the influence of age and gender on professional socialization and career commitment of advanced practice nurses,” Journal of Professional Nursing, vol. 16, no. 1, pp. 47–56, 2000.
[50]
S. L. Price, “Becoming a nurse: a meta-study of early professional socialization and career choice in nursing,” Journal of Advanced Nursing, vol. 65, no. 1, pp. 11–19, 2009.
[51]
B. Happell, “When I grow up I want to be a...? where undergraduate student nurses want to work after graduation,” Journal of Advanced Nursing, vol. 29, no. 2, pp. 499–505, 1999.
[52]
M. K. Rognstad, O. Aasland, and V. Granum, “How do nursing students regard their future career? Career preferences in the post-modern society,” Nurse Education Today, vol. 24, no. 7, pp. 493–500, 2004.
[53]
A. Rhéaume, L. Clément, and N. LeBel, “Understanding intention to leave amongst new graduate Canadian nurses: a repeated cross sectional survey,” International Journal of Nursing Studies, vol. 48, no. 4, pp. 490–500, 2011.
[54]
I. J. Deary, R. Watson, and R. Hogston, “A longitudinal cohort study of burnout and attrition in nursing students,” Journal of Advanced Nursing, vol. 43, no. 1, pp. 71–81, 2003.
[55]
V. Harvey and N. McMurray, “Self-efficacy: a means of identifying problems in nursing education and career progress,” International Journal of Nursing Studies, vol. 31, no. 5, pp. 471–485, 1994.
[56]
T. Kippenbrock, F. May, and C. Younnes, “Nursing students' attrition rates decline: a longitudinal study,” Journal of Nursing Science, vol. 1, no. 5-6, pp. 157–164, 1996.
[57]
V. C. Harvey and N. E. McMurray, “Students' Perceptions of Nursing: Their Relationship to Attrition,” Journal of Nursing Education, vol. 36, no. 8, pp. 383–389, 1997.
[58]
J. Stevens, A career with older people: do nurses care for it? [Ph.D. thesis], University of New South Wales, Kensington, NSW, Australia, 1995.
[59]
J. Stevens and M. Crouch, “Frankenstein's nurse! What are schools of nursing creating?” Collegian, vol. 5, no. 1, pp. 10–15, 1998.
[60]
B. Happell, “Turning the coin—emphasizing the opportunities in mental health nursing,” Issues in Mental Health Nursing, vol. 30, no. 10, pp. 611–614, 2009.
[61]
T. Kloster, M. H？ie, and R. Skar, “Nursing students' career preferences: a Norwegian study,” Journal of Advanced Nursing, vol. 59, no. 2, pp. 155–162, 2007.
[62]
J. A. Stevens and G. M. Dulhunty, “New South Wales nursing students’attitudes towards a career in mental health,” Australian Journal of Mental Health Nursing, vol. 2, no. 2, pp. 59–64, 1992.
[63]
J. A. Stevens and G. M. Dulhunty, “A career with mentally-ill people: an unlikely destination for graduates of pre-registration nursing programs,” The Australian Electronic Journal of Nursing Education, vol. 1, 1997, http://www.scu.edu.au/schools/nhcp/aejne/.
[64]
J. A. Stevens, “Student nurses' career preferences for working with older people: a replicated longitudinal survey,” International Journal of Nursing Studies, vol. 48, no. 8, pp. 944–951, 2011.
[65]
B. Happell, A. Robins, and K. Gough, “Developing more positive attitudes towards mental health nursing in undergraduate students: part 1—does more theory help?” Journal of Psychiatric and Mental Health Nursing, vol. 15, no. 6, pp. 439–446, 2008.
[66]
B. Happell and C. Roper, “The role of a mental health consumer in the education of postgraduate psychiatric nursing students: the students' evaluation,” Journal of Psychiatric and Mental Health Nursing, vol. 10, no. 3, pp. 343–350, 2003.
[67]
M. McParland, L. M. Noble, G. Livingston, and C. McManus, “The effect of a psychiatric attachment on students' attitudes to and intention to pursue psychiatry as a career,” Medical Education, vol. 37, no. 5, pp. 447–454, 2003.
[68]
C. M. Stuhlmiller, “Promoting student interest in mental health nursing,” Journal of the American Psychiatric Nurses Association, vol. 11, no. 6, pp. 355–358, 2006.
[69]
M. Lips-Wiersma and J. McMorland, “Finding meaning and purpose in boundary-less careers: a framework for study and practice,” Journal of Humanistic Psychology, vol. 46, no. 2, pp. 147–167, 2006.
[70]
C. White, “Ageing workforce will exacerbate NHS staffing crisis,” British Medical Journal, vol. 325, no. 7377, article 1382, 2002.
[71]
S. Welsman, “To boldly go! Can bright students realise their learning potential at Universities?” in AIC Partnership for World Graduates Conference, RMIT, Melbourne, Australia, November 2007, http://ssrn.com/abstract=1388742.
[72]
U. Bronfenbrenner, “Ecological models of human development,” in International Encyclopedia of Education, Elsevier, Oxford, UK, 2nd edition, 1994.
[73]
E. Bryan and L. A. Simmons, “Family involvement: impacts on postsecondary educational success for first-generation appalachian college students,” Journal of College Student Development, vol. 50, no. 4, pp. 391–406, 2009.
[74]
K. A. Renn and K. D. Arnold, “Reconceptualizing research on college student peer culture,” Journal of Higher Education, vol. 74, no. 3, pp. 261–291, 2003.
[75]
E. Chin and J. W. Young, “A person-oriented approach to characterising beginning teachers in alternative certification programs,” Educational Researcher, vol. 36, no. 2, pp. 74–83, 2007.
[76]
R. M. Lerner, “Career contributions of the consummate developmental scientist,” in Making Human Being Human: Bioecological Perspectives on Human Development, U. Bronfenbrenner, Ed., pp. 9–26, Sage Publications, Thousand Oaks, Calif, USA, 2005.
[77]
S. R. Zubrick, G. J. Smith, J. M. Nicholson, A. V. Sanson, and T. A. Jackiewicz, “LSAC research consortium, parenting and families in Australia,” Social Policy Research Paper 34, Commonwealth of Australia, Canberra, Australia, 2006, http://www.fahcsia.gov.au/about/publicationsarticles/research/socialpolicy/Pages/prps-prps_34.aspx.
[78]
U. Bronfenbrenner, “Interacting systems in human development. Research paradigms: present and future,” in Persons in Context: Developmental Processes, N. Bolger, A. Caspi, G. Downey, and M. Moorehouse, Eds., pp. 25–49, Cambridge University Press, New York, NY, USA, 1988.
[79]
J. W. Cresswell, V. L. Plano-Clark, M. Gutmann, and W. Hanson, “Advanced mixed methods research designs,” in Handbook on Mixed Methods in the Behavioural and Social Sciences, A. Tashakkori and C. Teddlie, Eds., pp. 209–240, Sage, Thousand Oaks, Calif, USA, 2003.
[80]
J. W. Creswell, Educational Research: Planning, Conducting, and Evaluating Quantitative and Qualitative Approaches to Research, Merrill/Pearson Education, Upper Saddle River, NJ, USA, 2nd edition, 2005.
[81]
J. C. Greene and V. J. Caracelli, Advances in Mixed Methods Evaluation: The Challenges and Benefits of Integrating Diverse Paradigms, New Directions For Evaluations, Jossey-Bass, San Francisco, Calif, USA, 1997.
[82]
J. W. Creswell and V. L. Plano-Clark, Designing and Conducting Mixed Methods Research, Sage, London, UK, 2007.
[83]
N. Hickey, J. Sumsion, and L. Harrison, “Why nursing? Applying a socio-ecological framework to study career choices of double degree nursing students and graduates,” Journal of Advanced Nursing. In press.
