Rabia Salim Allari

1Assistant Professor/College of Nursing,Al-Ahliyya Amman University,Amman,Jordan.

Abstract

Keywords:Career,Education,Female nurses,Image,Nursing,Nursing program,Perception,Profession

Introduction

Nursing is a health profession that takes a holistic approach to promote the physical,psychological,social,and spiritual wellbeing of individuals,families and communities.Nurses put all their efforts in promoting health,and assisting patients to adapt with their illnesses.Nightingale looked at nursing as an independent profession that was not subordinate but equal to the medical profession [1].Nursing is a challenging career that requires a major change from novice nurse into a competent registered nurse.So beginners in nursing career need support and guidance to feel comfortable in their role.

According to World Health Organization [2] there are a big worldwide challenges confronting healthcare professions which is the nursing shortage.Kingdom of Saudi Arabia (KSA) is facing a shortage,recruitment,and retention problems.The total number of nurses in KSA is about 83.862; Saudi nurses are 57.8% of the total number of nurses[3].Nursing has usually been an unacceptable career option,and few females studied nursing in most Arab countries,nursing has been generally restricted to the area of maternal care [4].Saudi public perception of nurses was a major factor in the nurse shortage because of many reasons such as being low paying job,low class,long working hours and night shifts,and Saudi female nurses facing a hard time in this profession from strict culture.All these reasons have ruined the nurses image in which are accordingly affect recruitment and retention of nurses in health care sector[4,5].

Few studies tackled the subject of how students perceive the nursing profession upon entry into a nursing program in higher education[6].Public as well as students who want to study nursing have slight knowledge about the different levels of nursing practice or nursing education requirements [7].And this might affect the graduates' nurses by experiencing shock and disappointment in their first years of practice and lead them to leave the profession [8].Worldwide,the nursing students viewed nursing as a caring and helping profession involves a lot of patience,experience,and practice.Their perception toward nursing profession positively changed over the academic years and the majority of them perceived nursing as a humanitarian job.They found that their profession has a positive impact on their personalities and ensure their economic status in the future [9-11].Yet,many students thought that nursing is not as respectful and dignified profession by the society[12].

Regionally in Arab countries,many studies showed that nursing students have positive perceptions in Jordan and Egypt and the students joined the nursing because of financial reasons or availability of work[13,14].In a study exploring the perception of first year nursing students and the results highlighted the student’s personal desire to become a nurse for only 31.0%,while 69.0%began a nursing career because of other reasons,such as family or economic pressures[15].Fourth academic year for nursing students is a turning point in their studying of nursing because it is the year when most of them are aware of the role as professional nurses and put a plan where to work[16].

Locally,in KSA one study was done to explore the perception of the Saudi community towards the nursing profession.Final year secondary school students were surveyed,86.6% of students had a respect for the nursing profession,and they indicated a lack of awareness in the community about nursing.Students concerns about nursing were around potential of marriage,the risk of infection and the lower financial remuneration compared to other professions[17].

Attracting students to nursing career is an important step to increase the number of nurses,but unfortunately the public perception to nursing profession as well as student’s perception is actually narrow.Nursing was positioned as best second choice to medicine,medical drama in television view the nurse as less skilled and less knowledgeable than physician [18].Student are looking for high status career and because students perception of nursing are limited to visible image instead of informed career decisions,many view nursing as taking order from physician [19].So the attempt to understand the students’perception of nursing profession in KSA can assist schools of nursing who experience pressure from national government,healthcare organizations,and communities to increase student enrollment in nursing programs to fill current shortage,to evaluate the student’s readiness to change their perception positively because occasionally,they are disappointed by the challenges they encountered during nursing education and in clinical placements[20].

The purpose of this study is to investigate the female nursing student’s perception of the profession among first year and fourth year students,and to compare between their perceptions.

Methods

This study is an exploratory descriptive comparative.It was conducted at one of the biggest female governmental universities in KSA in the college of nursing.The study involved a convenient sample of 300 currently enrolled bachelors nursing students from the first and fourth academic years.Ethical approval from the university institution review board was obtained.Participants were informed about the purpose of the study and the right to participate and withdraw at any time without any consequences.Anonymity and confidentiality were assured.

Self-administered questionnaire which developed and published by Al-Jarrah was used in this study[13].It includes three parts:sociodemographic characteristics,Likert scale that contains 22 statements about image and perception of nursing profession,questions related to social rank of nursing profession,feeling about nursing profession,reasons for enrollment in nursing programs,factors contributing to the change to better and worst in nursing image after joining faculty of nursing,and student’s job prospective or students' plans after graduation.The tool was translated forward-backward from English to Arabic to avoid any possible misunderstanding [21].A pilot study was conducted and Cronbach’s alpha was=0.61.

Results

Data were analyzed using SPSS version (22.0).Descriptive comparative statistics were done using percentage,arithmetic mean,standard deviation,and two sample t tests.

Demographic characteristics presented in Table1 included 300 participants with response rate of 95%,50.9% (n = 152) were first year nursing students and 49.1% (n = 148) were from fourth year.The average age was 20 years,95% of the sample was single,and 5%were married.56%(n=64)of study sample have a nurse friend or relative.

In terms of family reaction to the enrollment in nursing program,the majority of students’ (42.9%)family reaction to their enrollment to nursing faculty is neutral,also (35%) of the sample family reaction to their enrollment is positive,whereas,(22%) of the students perceive negative family reaction.

Table1:Demographic data(N=300)

Students perception toward nursing profession results showed in Table2 that both first and fourth year students agreed that nursing profession is humanitarian,significant,essential for the society,helpful,and provide self-actualization with the highest mean scores.While,both strongly disagree that,it is wasting of time,similar to a servant’s job,exclusive for female,and an occupation not a profession with the lowest mean scores.Clinical training influenced both positive and negative changes in the perception of the students.

When comparing the perception of first and fourth year nursing students about their perception of the profession as showed in Table2,there are no statistical significant differences between the means of first year nursing students and those in the fourth year concerning perceptions of nursing as a profession.As the first year students agree with total average mean score of(3.631)and the fourth year students agree with mean of (3.637).Which are considered as positive perception? The students’ perspectives in terms of ranking of the nursing profession,the majority of the sample 45%(n=135)put nursing job at the first social rank among other jobs,while only 1% (n = 3) put nursing in tenth social ranks.

The participants in the study express their feelings toward the profession,and the result elucidated that 55.3% (n = 166) participants were proud of nursing profession when talking with others,while 28%(n=84)were defensive,12.3% (n = 37) who change topic when talking with others about nursing,and 4.4%(n =13)were shy of the nursing profession.

In regards to the reasons for enrollment in nursing programs,the results exemplify that the majority of nursing students 55.3% (n = 166) have joined the faculty of nursing due to grades in foundation year,while 28.9% (n = 87) have joined the faculty of nursing to help others,also 6.1% (n = 18) have joined the faculty of nursing because of a financial reason or availability of work,3.6% (n = 11) have joined the faculty of nursing due to an advice from family members,whereas 6.1% (n = 18) have joined the nursing because of secondary school grades.

Table2:The five highest and lowest ranked items of perception of nursing profession and difference between first and fourth year.(N=300)

In terms of factors contributing to the change to better and worst in nursing image after joining faculty of nursing,the results clarified that the following factors contributing to change perception to better:the majority (38.6%) of study sample see that clinical training as the most important factor,(22.8%)from the effect of faculty members and relationship with medical staff,(20.2%) in their opinion relationship with friends is the contributing factor,(17.5%) due to public view about nursing,and (11.4%) mention working conditions,(10.5%) see that family member opinion is the factor.

On the other hand,the majority of students (28.1%)of study sample see that public view about nursing is the most important factor contributing to change to worst in nursing image after joining faculty of nursing,and (26.3%) consider clinical training as the factor,whereas(22.8%)mention working conditions,(18.4%)put effect of faculty members as major contributing factor,while ((14%) perceive that relationship with medical staff,(9.6%) see that relationship with friends is the factor contributing to change to worst,and(8.7%)consider family member opinion.

In regards to students’ plans after graduation the results indicated that (21.1%) of study sample participants plan to join a teaching institution.while(60.5%) plan to join bedside nursing after graduation,whereas (53.5%) plan to join nursing administration after graduation.Also(80.7%)of study sample plan for higher education after graduation,while (30.7%) plan to change the profession after graduation.

Discussion

The sample of the current study consists of young female nursing students as the university understudy is a female university in KSA,in addition 168 participant have nurse friend or relative which point toward one of the reasons that motivate those students to enter nursing program.First year students viewed nursing as a human profession so it was the highest ranked item,despite that fourth year nursing students agree with them as well but they ranked the item as the second.This may be because it is the general view of the profession for the public.Also,it may be due to their lack of clinical experience so they have limited knowledge of the nurse’s role in the hospital setting and the difficulties they might face in the profession.On the other hand,majority of fourth year nursing students saw that nursing has a major significance in patient's recovery and helping in promotion of health and prevention of diseases,these results were supported by a study that found that the clinical area is a positive side of the nursing students experience[14].

In terms of the items that the students strongly disagree because it reflects negative image toward nursing was “Similar to that of the servants' job” for first year students,and “Nurses waste a lot of time being busy doing nothing”for the fourth year students.These results are reasonable according to the students’knowledge about nursing profession which is related to their academic year also their clinical experience.This finding is consistent with many studies[22-25].

There are no statistical significant differences between the means scores for both first and fourth year students concerning perception where it continued positively.However,fourth year students have more specific opinions and perception because they have more knowledge of the profession whether it was theoretical or clinical.This is in line with studies found that there is a high percentage of nursing students from fourth year had positive perception of nursing profession[26,13,14].

According to the results the reaction of the families to the enrolment in nursing programs was neutral to positive which showed that the perception is changing due to improvement in public knowledge about the importance and nature of nursing profession.The majority of study sample put nursing job at the first social rank.This indicates that there is an improvement in perception of nursing profession among the students may be due to college efforts in counselling the students and changing their image,also the media role that clarify more realistically and honorably the role of nurses in health care facilities.This study result is different from the results of Aljarrah in Jordan,where the majority ranked nursing profession as a third[13].

The result showed that the half of the students were proud about their profession,this could be an extension of college efforts toward improving the image of the profession.However; there was the other half of the students who felt defensive,change the topic and shy when they talk about nursing profession,that could be related to negative public image,lack of communication and confidence,and lack of interest in nursing.Similarly Aljarrah reported that the majority of the students (80.9%) in his study feel proud when talking about nursing profession[13].

More than half of the students enrolled to faculty of nursing because of their foundation year grades,that's maybe due to lack of awareness toward nursing profession and the university policy that not cooperated with the requirements of nursing profession,this result is different from the findings of Jrasat,et al.,where there was 96% began a nursing profession because of family wishes or economic reasons [15].In addition,some researchers claimed that one of the reasons that interfere with students study interest is the university admission policies,in which,students are allocated to different faculties according to their secondary school grade [27].But the result of this study regarding reasons for enrollment to the faculty of nursing is consistent with many other studies[28,25].

For fourth year students,the highest ranked factor that changed the nursing image to a better was the clinical training,that may be due to impeccable experience in clinical training in hospitals who have a role in giving the students positive image of nursing profession.Especially when they offered the students the opportunity to interact with the health care team,practice nursing and acknowledge the significance of their role in the hospital.This result is similar to Al Jarrah study[13].

The public view was the main factor that contributed to the change to worst in nursing image.Which is mentioned by many researchers as the first reason because the public knowledge about the nursing profession is very narrows [7].This may motivate the government to focus on improving the society image and increase the awareness toward nursing profession.

Majority of the students had a desire to continue higher education after graduation.This may be due to the lack of Saudi faculty members which attract the students’ attention for the importance of higher education and the shortage that present in this field,also the shortage in specialized Saudi nurses with advanced practice that they faced during their clinical education.Similarly,in India,84% of the participants preferred to go for higher education [11].On the other hand,60% of the students in the current study were more interested in being a bedside nurse.This shows that students want to work where there is more interacting with the patients in order to gain more skills and improve their competencies in nursing.Dissimilar with Swarna where about half of the students (46%) are not interesting to be a bedside nurses[11].

Many students in this study are planning to join nursing administration after graduation.This would be because of the programs efforts toward encouraging the students to improve leadership and management skills,also the students are aware of the shortage in Saudi nursing administration experts,in addition,the high salaries of nursing administrators and the benefit of avoiding long working hours,night shifts and patient care responsibilities.All these factors raise the students' interest in administration positions.Aljarrah results were different,14.7% of nursing students only preferred to work in nursing administration after graduation [13].Whereas,the ideas of changing the profession were found to be high in percentage,due to different reasons such as public negative image,difficult working environment,and lack of interest in the profession.

It is worth wise mentioning that the fourth year students had high percentage toward plan for teaching than first year students.That may be due to the clinical training and their concerns regarding the long hour's shifts,and difficult patient care and career responsibilities.This result is in line with many other studies[11,12].

Conclusion

This study is the first to examine female nursing student’s perception toward profession in Saudi Arabia.The students generally continued to have a positive perception toward nursing in first and fourth year.However,most of the students enrolled in nursing because of their foundation year grades but they mostly felt proud talking about nursing.The idea of changing the profession was found in a high percentage due to the media false representation of nursing and lack of awareness in the society.However,there are many students who have plans to join bedside and administrative positions and this may be an indication for a possible decreasing in the shortage of Saudi nurses.Nursing college administration offices should put more efforts in improving the student's and public perceptions and increasing their awareness about nursing career through campaigns.Also the role modeling is considered as effective strategy to inspire the students and make them more proud about nursing profession.Hospitals can also collaborate with the nursing programs to improve the image and offering a good experience for students.