Gender and students’ vocational choices in entering the field of nursing

Article Outline

• Abstract
• Method
  • Sample
  • Instruments
  • Procedure
• Results
• Discussion
• References
• Biography
• Copyright

As the demand increases for nursing professionals, existing theories borrowed from the field of industrial psychology may help employers and recruiters to identify appropriate candidates, train, hire and promote nurses in a more effective manner. An important component of these theories is understanding an individual’s motivation to choose a certain profession. This preliminary study examined gender differences in motivations to enter the field of nursing. Two theoretical points of view were offered to account for the differences: Holland and Row’s models of person-job congruence and Maslow’s hierarchy of needs. One hundred and sixty (24 men and 136 women) freshmen from 3 nursing programs were asked to report their motivations to enter nursing. A new instrument based on the models mentioned above and representing 2 basic motivations, self-actualization and survival needs, was developed for the purposes of this study. While both genders mentioned self-actualization as their main motivation for entering nursing, men tended to give survival needs more weight than women did. The motivation patterns as well as the gender differences are discussed in light of recent trends in nursing and within the framework of personnel selection and training.

Despite the gradual changes in nursing as a profession, its image and composition remain predominantly female. Male nurses are a minority representing only 5–6% of the persons holding a nursing license in the US.¹ A recent surge in the interest in nursing has placed the profession in the privileged position of increasing its level of selectivity when screening candidates applying to schools of nursing. Understanding the role of motivation in the choice of nursing as a vocation and, more specifically, how gender affects motivations for choosing nursing as a career, may provide insight into recruitment, retention, and the redressing of the gender gap in nursing. The aim of this preliminary study was to assess the effect of gender differences on college freshmen’s motivations to select nursing as a career.

One of the theoretical frameworks employed in this study is the model of vocational choice based on Holland’s² and Roe’s³ classifications of professions and jobs. This model focuses on the congruence between a vocational profile of a given profession/job and a personal profile, maintaining that people choose professions requiring skills, tendencies and capacities that they possess.⁴ Various professions were originally classified into 8 fields: Business, organization, general/culture, service, arts and entertainment, outdoors, science and technology.³ The fields are set in a spherical structure assuming that proximity between fields also represents a conceptual proximity in fields of interest. For example, “technology” is adjacent to both “science” and “business” while being farther away from “arts and entertainment”. Other models, stemming from this original model, have been suggested through the years but they have maintained the same underlying assumptions and ideas conveyed by Roe’s model.⁵, ⁶ The dynamics of the models have also remained very similar, assuming that congruence should occur between the “personality” of a given job and the personality of the person choosing it.

The notion of congruence between individual personality and job personality is not new in the organizational psychology literature. While research is still ongoing, evidence points to the consequences of congruency, such as job satisfaction, levels of turnover, and job performance.⁴, ⁷ The existing evidence suggests that the stronger the match is between the person’s profile of motivations, interests and skills, and the job’s “personality” (demands, requirements, environmental characteristics), the higher are the chances of achieving more positive outcomes, as mentioned above. The models suggest that congruence is more of a continuum than a categorical state (eg, the existence or lack of congruence). Based on this evidence, it has become commonplace to measure vocational interests in vocational counseling, rehabilitation, educational counseling, and job screening.

The congruence model can inform our understanding of the profession of nursing and those who choose to enter into it in 3 important ways. First, better understanding the reasons for which people choose nursing as a career may serve as a first step on the road to unraveling the question of congruence between nursing school candidates’ characteristics and their match with the potential for a successful career in nursing. Second, the congruence model suggests that people choose careers because they see a good fit between who they are and what the job is about. In other words, from a congruence model perspective, vocational motivation is characterized by a desire for self-fulfillment. This observation begins to shape what may be a path to greater selectivity in recruitment to the field of nursing. Third, the model also suggests strategies for addressing the perpetuation of gender bias in nursing. Understanding gender differences as a function of concepts inherent in the congruence model may provide insight into the recruitment of men in nursing and the retention of both men and women in the profession.

Abraham Maslow’s model of hierarchical needs is one of the classic views of human development in psychology.⁸ A hierarchy of needs, ranging from basic survival, through security, love and acceptance, satisfaction/esteem to self-actualization is described as the source of human motivation to act, defining both challenges and ways of action. Through the lens of this model, vocational choice is an action that may be aimed to meet any of the needs along the hierarchy. For the purpose of this study, work is interpreted as a means of meeting the very basic survival needs. The application of Maslow’s model in this study may, unlike the previous model, include the possibility that a vocational choice of nursing is based more on financial need, practical considerations (eg, job security, benefits, etc.) and employability rather than on self-actualization and fulfillment. This perspective of vocational choices may account for the subtle increase in male membership in the nursing profession.¹ The traditional male gender role in American society continues to depict the adult male as provider and bread winner.⁹ Currently, nursing is offering more job security and employability than many other fields in the current economy¹ and may, therefore, be an increasingly attractive option for men.

There is a substantial body of research in industrial/organizational psychology on vocational choice and job-related outcomes¹⁰, ¹¹ as well as college major selection and professional training.¹² In the nursing profession, however, there is only meager empirical evidence regarding the factors affecting vocational choice and the associated outcomes.¹³ Interestingly, however, the nursing literature has an abundance of articles addressing issues such as the need for recruitment, development, retention, avoiding burnout, and the demographic characteristics of nursing students and professionals.¹⁴, ¹⁵, ¹⁶ To effectively discuss issues of recruitment, development, and retention, more must be understood about the relationship between an individual’s characteristics and motivations, and movement into the profession as well as success as a nurse. This study represents an initial effort to apply psychological theories used in vocational assessment to understand freshman-level nursing students’ decision to enter the field of nursing. Understanding motives as well as gender differences at this level can eventually lead to empirically based recommendations for educational institutions recruiting future nurses and for management in health care institutions seeking to retain nurses.

This study tested the following hypotheses: (1) Women will more frequently endorse their reason for choosing nursing as a perceived match between their own personality and nursing’s “personality” as a profession; and (2) Men will choose nursing for motivations based on survival needs such as employability and income at a higher rate than women.

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Method 

Sample 

One hundred and sixty participants, 24 men and 136 women, were recruited from 3 cohorts of freshman nursing students in 3 colleges and universities in the northwestern and mid-western USA. The sample, though not necessarily representative of the nursing student population in the US, provided enough statistical power for group comparisons (observed power coefficients ranged between .78 - .89).¹⁷ All participants were ≥18 years old and were capable of making an independent decision to participate (mean age = 21; SD = 6.19). All the participants had at least a high-school education. Seventy-five percent of the sample were Caucasian, 13.8% Asian, 5.7% African-American, 3.8% Hispanic-Latino while 1.7% noted other ethnic backgrounds. Most of the participants indicated they chose nursing as their first career. Twelve percent of the participants were either returning students or selected nursing as a career change.

Instruments 

The instrument used in this study, which was developed by the investigators, was a self-report questionnaire assessing participants’ motivations and reasons for choosing nursing as a vocation. Items included statements such as, “I always wanted to be a nurse” and “I always wanted to help people”. Respondent agreement (or lack of it) with the statement was recorded on a Likert-style scale modified to assess proportions from 0–100%. The questionnaire also included a demographic section.

The items were based on the assumptions of both the vocational congruence model and the hierarchy of needs model. A panel of 7 content experts assessed the measure’s content validity. All panel members were nurses with graduate education and ≥10 years of professional experience. Two members were men. The experts were asked to assign each item as either “vocational congruency” motivations, “survival” motivations (from Maslow’s hierarchy of needs model), or to define the item as “undifferentiated.” The experts were also encouraged to propose additional items or rephrase existing ones. The items included in the instrument are those on which at least 6 of the 7 experts agreed upon as representing “vocational congruency” choices or “survival” choices. The content experts agreed unanimously on categorization of 19 (92%) of the 21 total items initially suggested.

As a second step of the instrument validation process, an exploratory factor analysis (EFA)¹⁸ was conducted. The analysis yielded 2 factors accounting for 66% of the total variance. With a loading coefficient cut point for inclusion in a factor of .45 or better, the items showed reasonable support for the 2-factor model.¹⁸ The exclusive division of items into 2 factors also supported the 2-model structure. The questionnaire items and their assignment into “vocational congruency” or “survival” categories determined by the content experts with the factors loadings yielded by the EFA are listed in Table 1. Of the original 21 items, only those that were consistently assigned to one of the factors (congruency/survival) by all panel members and the EFA were included in the final version of the questionnaire, resulting in a 20-item instrument and an additional item titled “other” for the participants to add information in case of need.

Table 1. Item Analyses by Judge Panel and EFA

Judge decision: C = congruence; N = survival/need. (*) marks less than uniform decision by judges.

Criterion for factor inclusion = loadings > .45

Factor analysis accounted for 66% of total item variance.

n (men) = 24; n (women) = 136.

Procedure 

The study was reviewed and approved by the human subjects committee at the lead author’s institution and was also approved by the other institutions at which data was gathered.

Participants were approached in groups by the investigators and were asked to volunteer for “a study examining men and women’s reasons for entering the field of nursing.” Participants were assured that they would remain anonymous and that there were no academic or professional consequences of their decision regarding participation. Students who agreed to take the questionnaire were asked to fill it out alone and in privacy. Participants had the option of taking the questionnaire with them and returning it in a self-addressed stamped envelope. The questionnaire required 15–20 minutes to complete. One hundred ninety-six students were approached and 160 (81.60%) completed the questionnaire.

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Results 

The 3 samples (n₁ = 60; n₂ = 79; n₃ = 21) from 3 different nursing programs were not significantly different on background variables such as education level, ethnicity, and gender distribution. For the 1-way analysis of variance (ANOVA) used in the preliminary examination as well as the t-tests used to test the hypotheses, Bonferroni’s¹⁷ correction was used to control for multiple comparisons, with a resulting criterion for significance set at P < .02.

Participants from the third sample were significantly older than individuals in the other 2 groups and their responses were examined for differences on a random sample of the questionnaire items. Since no differences were found, the 3 samples were combined for the rest of the analyses (F₁₅₆ = 1.39; P < .23).

Table 2 shows the results of a comparison of item endorsement by men and women. The results suggest that men and women did not significantly vary in how they endorsed most of the items. However, a few interesting gender differences arise. Men endorsed the following items more than women (see Table for group-comparison statistics): “I wanted to learn something else but was not accepted”; “ I want to have a profession that is always in demand”; “Nursing is a respectable profession in the eyes of others”; “There’s no unemployment in nursing”; “It’s good money” and “I think I can become a leader in this field.” Women endorsed the statement “Others always told me I could be a good nurse” more frequently than men.

Table 2. Gender Differences in Item Endorsement

n (men) = 24; n (women) = 136.

Table includes validated items only.

For each factor (ie, items corresponding with “congruence” or with “survival” categories), grades were calculated based on the weighted average of items included in each factor. The Cronbach’s internal consistency coefficients for each factor, congruency and survival, was .86 and .78 respectively. A gender comparison of the factorial subscale grades reconfirmed the results shown by examining the individual items. Table 3 provides the relevant comparisons. Both men and women showed high endorsement of congruence-related considerations for choosing nursing (t₁₅₈ =.64; P < .42). Survival-related considerations were generally endorsed less by both men and women; however, men seemed to consider survival aspects significantly more than women (t₁₅₈ = 6.89; P < .01).

Table 3. Gender Differences on Factorial Grades

Factor	Men		Women		t(df)	Sig.
	Mean	SD	Mean	SD
Factor 1 (Survival/need)	37.82	15.78	27.47	16.95	6.89(158)	.01
Factor 2 (Congruence)	69.83	16.98	66.50	17.78	.64(158)	.42

n (men) = 24; n (women) = 136.

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Discussion 

The results seem to provide partial support for the hypotheses regarding men and women’s different motivations for entering the field of nursing. This difference, however, was not evident in most items related to the person-job congruence factor. This may suggest that people who did make a preliminary commitment to nursing (ie, were accepted in a nursing school, paid tuition and started taking classes) did so for reasons related to a perceived fit between themselves and the profession of nursing. Based on previous evidence from other professional fields and one other study conducted on nurses using the congruence model, this choice may be expected to yield desirable results in the long run, such as low turnover rate, increased job satisfaction and better job performance.⁴, ⁷

Gender differences were apparent, however, in survival and need motivations for entering nursing. While women tended to de-emphasize survival and need considerations when choosing nursing, it appears that men put greater emphasis on aspects such as salary, job security and the social image of the profession. Two significant exceptions to this tendency were noted. Men endorsed the statement “I think I can become a leader in this field” (congruency statement) at higher levels than women. Women tended to more highly endorse the statement “Others always told me I can be a good nurse” (congruency statement). Both deviations seem to reflect traditional gender roles,⁹ with men seeking leadership and advancement, even in a relatively “feminine” profession, while women report getting messages from their social environments about their suitability for the nursing profession.

Existing theories and models in vocational and organizational psychology may be relevant to the field of nursing, especially in the areas of student and staff selection, recruitment, training, performance and long-term retention.⁷, ¹³ There is ample evidence in various fields suggesting that understanding people’s motivations and interests in entering a profession may serve as an important tool in these areas.¹⁰, ¹¹, ¹² Within the field of nursing, constant discourse is taking place about attracting high quality candidates to training programs and diverse work settings.¹⁴, ¹⁶ To date, however, the well-known theories and applications of vocational and organizational psychology have been underutilized in nursing. This study attempted to promote the application of vocational selection models to understanding the reasons and motivations for which persons enter nursing. Observing gender differences in those motivations, particularly in a vocation like nursing which is predominantly female,¹ may be of special interest and relevance.

The potential benefits of this research in nursing are relevant as programs of nursing are experiencing an increase in enrollment in college and university programs. The results of this study suggest empirically based candidate selection may be useful in the future. Recently, programs of nursing have given little thought to candidate selection beyond ACT, SAT, and GPA criteria. It might be argued that the quality of the educational process has been compromised by this “open-armed” approach. The introduction of theory based in vocational psychology to the nursing education process during a time when programs can afford to be selective may present an opportunity for nursing to increase the quality of its ranks. New ways may be explored to examine candidates’ vocational congruence with the profession of nursing based on the evidence collected in studies such as this one. Given a substantial body of evidence linking certain motivations, personality traits, and skills to better performance, retention and other possible outcomes, nursing schools and employment settings can screen and select candidates using empirically-based criteria.¹, ⁴, ¹³

A more immediate application of the findings here suggests that those behind the efforts to address the nursing shortage by increasing enrollment in nursing programs may be enhanced by thinking carefully about recruitment. Advertisements and appeals that speak directly to the motivating factors strongly endorsed in this study may increase the effectiveness of their attempts. Further consideration of gender-specific motivations may also inform the individualization of recruitment schemes.

This study had several limitations. The limited sample size of 160 freshmen students from 3 institutions, though satisfactory in statistical terms, may not provide proper representation of the population of persons considering nursing in the US. Additional samples with diverse characteristics may help validate the preliminary results reported herein. The use of self-report questionnaires, though common in the measurement of psychological constructs in nursing,¹⁷ may be vulnerable to issues of social desirability and other biases that threaten the validity of the responses provided. These kinds of biases are expected to work against the finding of gender differences and other effects. The fact that such affects were found in this study only strengthens the validity of the findings. Additional measures of motivations to enter nursing (eg, structured interviews, focus groups, etc.) may provide important data beyond what was found in this study.

This study’s findings suggest a link between gender and motivations for entering nursing. A possible next step in this area of research would be replication of this study with a larger and more representative sample. A further step is to test the relationship between motivations for entering nursing and performance at nursing school and professional outcomes in various practice settings. Though evidence borrowed from other fields of application strongly suggests that such a link exists, it is time nursing developed its own unique body of empirically based “know-how” in this potentially important area.

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