Does nursing have an image problem that scares off potential nursing students? Here's what high-school students and adult career-switchers think about nursing as a potential career choice.


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INSPIRED BY THE growing nursing shortage, we surveyed high-school students and adult career-switchers about their interest in nursing as a possible career. We made a startling discovery: Only 5% of students and 3% of adults said they'd choose nursing as a career. We also learned that being happy at your job is the number one motivator for both students and adults-yet only 35% of students and 33% of adults believe that nursing provides this benefit.


Today, 1 in 10 nursing jobs is unfilled in the United States. According to the Bureau of Labor Statistics, the nursing shortage will reach 1 million nurses by 2012. Our telephone survey, commissioned by nurse-executives in the Partners HealthCare System (Partners Chief Nurse Council), was designed to address this crisis. Besides exploring what potential nursing students look for in a career, we wanted to identify deterrents that might steer them away from nursing.


In this article, we'll discuss key findings from this survey, which was based on 800 telephone interviews. (See About this study.) We'll also suggest ways you and your colleagues can use this information at the grassroots level to attract more bright young people and seasoned adults to nursing.


What's the single most important reason for a career choice?

Respondents were asked about their reasons for career choice in two ways: First, they were asked to name the single most important factor for making a choice; then they were asked to rate various career choice motivators in order of importance. We then compared the answers of respondents interested in nursing in both age-groups with those of all respondents in each group. From this data, we learned that "being happy at work/liking your job" was the single most important career motivator for both students and adults. Among students, happiness at work far exceeded all other reasons.


For adults interested in nursing, "a good salary" was most frequently chosen as the single most important reason for a career choice. (See What's the single most important reason for a career choice?) "Flexible schedule" was also important for adults overall (more so than for students). But as we'll discuss shortly, less than a third of all respondents see nursing as providing these benefits.


Although happiness at work was a strong choice for all students, those likely to choose nursing were notably less likely than students as a whole to identify it as the single most important factor. Significantly more of them identified "good salary/money" and "a sense of making a difference in people's lives" as the most important motivator.


Relative strength of motivators of career choice

Respondents rated the importance of various motivators on a scale of 1 (not important) to 5 (very important). Overall, 80% of both students and adults rated "being happy at your work" as very important.


Here are students' top motivators. (The first percentage shown is for all students; the second is for students interested in nursing.)

Figure. Whats the si... - Click to enlarge in new windowFigure. What's the single most important reason for a career choice?

* a sense of making a difference/benefiting people's lives (57%/71%)


* a sense of feeling what you do is important (50%/67%)


* having a stable, secure job (47%/56%)


* good salary/money (43%/50%).



Predictably, adults have different priorities than teenagers. Like students, adults ranked "happiness at your work" as the number one motivator, and "a sense of making a difference in people's lives" was also important. But as the following list shows, they differed from teens in other choices. (The first percentage shown represents all adults; the second represents adults interested in nursing.)


* a sense of making a difference in people's lives (56%/82%)


* good salary/money (50%/71%)


* interacting with people/working with a group of people you enjoy (47%/69%)


* a sense of feeling what you do is important (52%/63%)


* feeling you're part of a team (40%/60%)


* learning/growth opportunities (54%/60%)


* advancement opportunities (39%/56%)


* many job options within the field (26%/42%).



Perceived benefits of a nursing career

Respondents were asked to what extent nursing provides various potential benefits. Students and adults were most likely to agree that nursing provides the following:


* a sense of making a difference


* a sense of feeling what you do is important


* working with a group of people you enjoy


* challenging responsibilities.



Yet relatively few respondents in the total teen and adult groups agreed that nursing provides "happiness at work," or the economic benefits of a flexible schedule, advancement opportunities, or a good salary. As we've already seen, these are among the highest career choice motivators for many survey respondents, so the perception that nursing doesn't provide these benefits is damaging.


Those interested in nursing saw nursing more positively compared with those in the total group. Both teens and adults interested in nursing associated these benefits with a nursing career: a sense of making a difference, a sense of feeling what you do is important, and working with people you enjoy. Adults likely to consider nursing believed flexible schedules were provided by a career in nursing-an important career choice reason mentioned earlier by all adults. But significantly, most students who expressed interest in nursing don't think nursing offers strong benefits in terms of stability/job security, salary, or flexible schedule. Informing students about these benefits could raise interest in nursing among young people.


Deterrents to choosing a nursing career

Among respondents who weren't likely to consider nursing as a career choice, "interest in another career" was the number one reason cited, particularly for teens. "Unappealing responsibilities/performing menial/cleanup tasks" was next. For adults, this deterrent and the need for more education were equally significant. (See What turns people off about nursing?) Interest in other careers and the fact that education takes time are factors that we can't do much about. But informing the public about the high level of skill and education nursing requires could counter the misperception that nursing is "cleanup" work.


Descriptions of nursing

Respondents were asked to rate their level of agreement with several descriptions of nursing. (See How would you describe nursing?) Both groups voiced the highest agreement with these points:


* Nurses need to have a solid understanding of medical technology.


* Nurses have to react quickly to situations in a fast-paced environment.


* Nurses are professionals who need to be skilled in the latest medical technology.



But only 39% of teens believe nurses are critical thinkers and capable, intelligent problem-solvers. And just 29% of adults believe nurses are becoming more respected and appreciated in the workplace today. Of note, less than 20% of teens and adults believe nurses earn a starting salary of $45,000 per year.


Communications about nursing

Receiving information about nursing is associated with making nursing a career choice. Of adults who indicated an interest in nursing, 8% reported having spoken to someone about the nursing profession in the past 6 months; only 2% had not. (See Have you spoken to a nurse recently?)


The influence of these communications was equally striking among students: Of those indicating an interest in nursing, 10% had spoken to someone about the profession and 3% had not. Among students who'd choose nursing as a career, 9% had heard or seen something in the news or in entertainment that influenced their view of nursing in the last year; 3% had not. (See Have you been influenced by nurses in the media?)


Among students interested in nursing, 29% reported having seen or heard something in entertainment or in the news during the last year that changed their view of nursing. Media communications were less influential among adults. (See How the media influence opinions about nursing.) For most respondents in both groups, media communications had a positive effect.


What we learned

Clearly, "happiness at work" is important to everyone. However, students and adults interested in nursing are also highly motivated by the psychological rewards of "a sense of making a difference" and "a sense of feeling what you do is important." Adults interested in nursing are also highly motivated by a "good salary," "job stability," "interacting with people you enjoy," and "flexible schedule."


Unfortunately, many teens and adult career-switchers have a negative image of nursing and don't perceive nursing as providing many of these benefits. Nor do they understand the day-to-day realities of nursing. For example, they believe that nurses perform menial, cleanup tasks. Most students don't think of nurses as critical or creative thinkers. Adults are much more likely to see nurses as overworked. Very few of either group believed the starting salary for nurses is $45,000. These negative perceptions must be dispelled.


Teens who'd spoken with someone about a career in nursing during the past 6 months and teens who'd heard or seen something in the news or entertainment media that influenced their view of nursing are three times as likely to choose nursing as a career than those lacking in these communications. Personal communication with nurses and the media are also powerful influencers for adults.


To reach and influence both groups, we recommend nursing campaigns that let nurses speak to young people and career-switchers about the reality of nursing through presentations at schools and hospital-based "shadow a nurse" programs. Such a campaign should communicate the benefits of nursing, such as a sense of making a difference and benefiting people's lives; a sense of knowing what you do is important; good salary; job stability; and schedule flexibility. Emphasizing the motivating messages should be a productive way to attract more people to nursing.


Jeanette Ives Erickson is senior vice-president for patient care and chief nurse at Massachusetts General Hospital (Boston); Lauren J. Holm is staff specialist at Massachusetts General Hospital and Partners HealthCare System in Boston; Lee Chelminiak is communications manager, community benefit programs, Partners HealthCare System; and Marianne Ditomassi is executive director for patient-care services operations at Massachusetts General Hospital.

Table. How the media... - Click to enlarge in new windowTable. How the media influence opinions about nursing

About this study

To explore motivators and disincentives for choosing a nursing career, the Partners Chief Nurse Council commissioned the advertising firm of Hill, Holliday, Connors Cosmopulos, Inc., to conduct a market research survey. Surveyors conducted 400 telephone interviews of people in two target groups: teenage students in grades 7 through 11, and adults ages 18 to 49 who said they'd consider switching careers. The two groups were selected using random-digit telephone dialing to telephone exchanges located within zip codes in the metropolitan Boston area. Each sample was predetermined to be 75% female and 25% male. Conducted in the spring of 2002, the interviews averaged 13 minutes.


With Issues in Nursing, our purpose is to lay the groundwork for further discussion about current controversies in the nursing pro-fession. To succeed, we need to hear from you. Please write to tell us your views; we'll publish a sampling of reader response to this topic in an upcoming issue. E-mail us at; place "Issues" in the subject line.