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Publication Date: October 25, 2022
DOI:10.14738/aivp.105.13237. Salminen-Tuomaala, M., & Herttuala, N. (2022). What Factors Influenced Students’ Decision to Choose Nursing? European Journal
of Applied Sciences, 10(5). 284-293.
Services for Science and Education – United Kingdom
What Factors Influenced Students’ Decision to Choose Nursing?
Mari Salminen-Tuomaala
PhD, Seinäjoki University of Applied Sciences, Finland
Niina Herttuala
MNSc, Tays Kehitysyhtiö Oy, Tähtisairaala, Finland
ABSTRACT
Nursing staff shortage has become a serious challenge worldwide while the number
of applicants for nursing courses is decreasing. The identification of factors for
choosing the profession is important for planning recruitment strategies. This
observational quantitative study presents nursing students’ perceptions of factors
that had influenced their decision to apply for the nursing program. The aim is to
produce knowledge that can be used to make the profession more attractive to
potential workforce. Data was collected in March 2022 from 94 first, second and
third-year nursing. The students responded to an online questionnaire with 12
quantitative items using the Likert rating. The data was analyzed using SPSS for
Windows 27. Percentages, frequencies and measures of central tendency were used
to present the results. The STROBE checklist for cross-sectional studies was used to
help conduct the study. Intrinsic factors; desire to help the ill and suffering, in
interaction with people, and the idea of being suited for the profession had been the
most compelling motivators for the students. Some extrinsic factors; job security or
favorable employment situation, had also significantly affected the students’
decision to apply to the nursing program. Professional prestige, the social media or
other people’s opinions had not much affected the students’ decision to apply.
Keywords: Nursing student, nurse education, motivation, attractiveness, quantitative
research
INTRODUCTION
The nursing staff shortage has become a serious challenge worldwide. The number of
applicants for nursing courses is decreasing [1, 2]. Fewer nurses entering the profession,
combined with the expanding older population and aging healthcare staff, have led to a genuine
workforce crisis [3]. The crisis has been aggravated by the COVID-19 pandemic [4], by an
increased turnover (nurses leaving an organization or the profession) and failure to recruit and
train adequate staff to make up for the losses [5].
Further research on the career choices and perceptions of prospective nurses is required to
examine what factors influence prospective nurses’ perceptions, where the perceptions
originate, why they persist and what could be done to address these concerns [2]. This study,
conducted in Finland, presents nursing students’ perceptions of factors that had influenced
their decision to apply for the nursing program. The study aimed at producing knowledge that
can be used to make the nursing profession more attractive to potential workforce.
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Salminen-Tuomaala, M., & Herttuala, N. (2022). What Factors Influenced Students’ Decision to Choose Nursing? European Journal of Applied
Sciences, 10(5). 284-293.
URL: http://dx.doi.org/10.14738/aivp.105.13237
BACKGROUND
It has been estimated that in addition to the current 27 million nurses and midwives, 9 million
new professionals will be needed globally by the year 2030 [1]. In the United States alone, the
health care industry has lost 20 percent of its workforce and 30 percent of its nursing workforce
over the past two years [6]. Common reasons for leaving the profession include burnout or
exhaustion and the wish to reach a healthier work-life balance. Other reasons involve staffing
shortage, lack of appreciation and low pay [7-9]. Finland, the country where this study was
conducted, has enjoyed a relatively high number of nurses; 13.6 per 1000 inhabitants in 2018
[10]. However, the government and researchers agree that by 2035, approximately 200,000
new employees will be required in the healthcare and social welfare sector in the country with
a population of 5.3 million [11]. Simultaneous ly, the number of students applying for nursing
courses at the Universities of Applied Sciences has decreased by thousands over the past few
years [12]. The identification of factors for choosing the nursing profession is important for the
planning of recruitment strategies.
A systematic review of 29 papers published between 2002 and 2013 revealed that the choice
to study health care was commonly motivated by intrinsic factors, for example desire to help,
or personal interest in health care [13]. The desire to help the ill and suffering has been
repeatedly documented as a major motivating factor for choosing a career in nursing [14- 16].
The desire to help reflects what are considered the core values of nursing (altruism, autonomy,
human dignity, integrity, honesty and social justice [17].
A number of studies have also reported that students choosing nursing have been influenced
by family tradition [18] and prior healthcare exposure [19]. In addition, practical aspects play
a role in career choices. Reasons for choosing nursing include, but a not limited to, job security
and a steady income employment opportunities [19, 20], availability of training close to home
[15], wish to work in other countries, relatively easy entry criteria, or failure to be admitted to
another course [18].
The social status of nursing varies across countries and continents. A study involving 1244 first- year nursing students in the Netherlands reported that the students did not consider the
stereotypical conception of nursing (female, subordinate, low status) a problem. It was also
discovered that students with some earlier nursing experience, who had selected nursing as
their first choice and whose aim was to make a career in nursing, were significantly more
positive towards nursing than other students in the program [21, 22]. Similarly, the authors of
a qualitative study conducted with 76 nursing students in Poland suggested that the new
generation of nurses seemed to stress professionalism rather than vocation, and believe in
improving the low prestige of the nursing profession [18]. In contrast, low professional
prestige, has been found to be a barrier for choosing a healthcare profession for example in
Saudi Arabia [23]. Nursing may be considered a course for students with poor academic
abilities, as reported in a study conducted in Singapore [19]. In research carried out in Scotland,
high academic achieving school pupils were not interested in a career in nursing because of the
low status of the profession and because of negative influence of significant others [24]
Strategies suggested for nursing recruitment vary depending on the cultural context. Liaw et al.
[19] suggested more exposure to nursing in early school years, more competitive salaries,
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increasing the understanding of the role and career of registered nurses, and support for those
interested in nursing but faced with opposition from their families. In Finland, research
conducted on the attractiveness of old age care and nursing as a career found that wellbeing at
work and the working atmosphere were among the most appreciated factors. For the practical
nurses in the study, mutual help and sharing of knowledge, as well as workplace learning and
mentoring increased the attractiveness of the profession [25]. The role of mentors, peers and
role models in the formulation of career expectations has been emphasized before by Price [26].
Studies carried out with social and healthcare students and professionals in Finland have
stressed the importance of community spirit, collaboration and mutual emotional support.
Having influence over working times and work-life balance have also been listed as factors
increasing the attractiveness of the profession [27, 28]. The various research results have been
used to formulate improvements to be used in marketing and recruitment and in curriculum
development [25]. A current challenge in nurse recruitment, as pointed out by Chicca and
Shellenbarger [29], is to understand the thinking and behavior of generation Z students (born
between the mid-1990s and 2012).
METHODS
Study Design, Data Collection and Analysis
This paper presents the results based on quantitative data from an online survey. The paper is
part of an observational cross-sectional study combining quantitative and qualitative data. The
STROBE checklist [30] for cross-sectional studies was used to help conduct the study.
In March 2022, 168 nursing students representing 7 student groups at a University of Applied
Sciences in Finland were contacted via e-mail. The students received a link to a questionnaire
and a cover letter explaining study purpose and aims and the voluntary nature of participation.
The response rate was 56% (n=94). The data collection occurred through Webropol, an online
survey tool used to create questionnaires and analyze and report data. The tool provides readily
available real-time data.
The questionnaire consisted of 3 background questions (age, gender and education), 12
quantitative items using the Likert rating and 3 open questions. The students were requested
to assess if the 12 factors presented had influenced their decision to choose nursing as a
profession very much (1), rather much (2), neither much nor little (3), rather little (4) or very
little (5). We designed the questionnaire based on a systematic literature review on factors
influencing the attractiveness of nursing. The literature review will be published later. The
quantitative data was analyzed using SPSS for Windows 27. Percentages, frequencies and
measures of central tendency are used to present the results.
Ethics
Potential recruits received an e-mail containing a cover letter and a link to an electronic
questionnaire. The letter explained the voluntary nature of participation. Returning the
questionnaire was regarded as consent to take part in the study. Ethics committee approval
was not required, because the study did not involve health service users [31]. The anonymity
of the participants was ensured at all stages of the study.
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Sciences, 10(5). 284-293.
URL: http://dx.doi.org/10.14738/aivp.105.13237
The work was carried out in accordance with The Code of Ethics Declaration of Helsinki of the
World Medical Association [32]. Ethical guidelines of the Finnish National Board on Research
Integrity TENK [33] were observed.
The response rate of 56% (94 students in 7 groups of students) can be considered adequate for
reliable research. The questionnaire was pre-tested with 6 students and 4 nurse teachers to
increase content validity. The questions were considered clear and logical, so no amendments
were required. The original data (in Finnish language) is available from the author on request.
The results of this study can be relevant for both national and international settings. They can
be used by educational organizations and nurse administrators to increase the attractiveness
of nursing as a profession.
RESULTS
Participant Demographics
The participants were 94 first, second and third-year nursing students in Bachelor programs at
a University of Applied Sciences in Finland. The majority of them (91.5%) were women. Their
age range was 20-60 years, with a means of 28 years and a median of 25 years. The participants
were requested to specify their highest education level. Their responses to this item are
presented in Table 1.
Table 1. Participants’ highest education level
Highest education n Per cent
Comprehensive school 0 0.0%
Upper secondary school 29 30.8%
Vocational qualification 29 30.9%
Post-secondary education 2 2.1%
Bachelor, University of Applied
Sciences
33 35.1%
Master, University of Applied
Sciences
0 0.0%
Bachelor, University 0 0.0%
Master, University 1 1.1%
More than third of the students had a Bachelor-level education from a field other than nursing.
Almost a third had a vocational qualification; among this group, there were a few participants
with a Practical Nurse (Enrolled Nurse) qualification. Another third had only attended general
upper secondary education before enrolling into their current Bachelor program.
Students’ Perceptions of Factors that had Influenced their Decision to Apply for the
Nursing Program
Table 2 shows the distribution of responses for each of the 12 questions. The students had
relatively clear opinions about what factors had influenced their decision to apply for the
nursing program; the middle option (neither much nor little) was never the most frequently
chosen response in this study.
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Table 2. Students’ perceptions of factors that had had influenced their decision to apply for the
nursing program
Factor very
much
(1)
rather
much
(2)
neither
much
nor
little
(3)
rather
little
(4)
very
little
(5)
mean median
a. My wish to help people who are ill and
suffering influenced my decision to apply
b. Nursing being appreciated in society
influenced my decision to apply
c. My family’s opinion influenced my
decision to apply
d. My friends’ choosing nursing
influenced my decision to apply
e. People close to me sharing their
experiences of working in nursing
influenced my decision to apply
f. Seeing people close to me in a patient’s
role influenced my decision to apply
g. My experience of helping people close
to me influenced my decision to apply
h. My wish to have a job that involved
social interaction and client service
influenced my decision to apply
i. My personal skills in supporting people
who suffer influenced my decision to
apply
j. The good employment situation in
nursing influenced my decision to apply
k. The student counselor’s
encouragement influenced my decision
to apply
l. The image of nursing in the social
media influenced my decision to apply
37.3% 46.8% 5.3% 8.5% 2.1% 1.9 2.0
2.1% 17.0% 22.4% 41.5% 17.0% 3.5 4.0
0.0% 13.0% 19.6% 27.2% 40.2% 3.9 4.0
0.0% 3.3% 12.0% 29.3% 55.4% 4.4 5.0
0.0% 9.7% 22.6% 34.4% 33.3% 3.9 4.0
7.5% 16.1% 14.0% 26.9% 35.5% 3.7 4.0
7.5% 20.2% 18.1% 28.7% 25.5% 3.4 4.0
33.3% 48.4% 7.5% 10.8% 0.0% 2.0 2.0
29.8% 44.7% 20.2% 4.2% 1.1% 2.0 2.0
11.7% 35.1.% 22.3% 19.2.% 11.7% 2.8 3.0
1.1% 6.4% 19.4% 26.9% 46.2% 4.1 4.0
0.0% 5.4% 18.3% 37.6% 38.7% 4.1 4.0
For the participants of this study, intrinsic factors seem to have been more decisive than
extrinsic reasons when deciding to apply for the nursing program. The desire to help the ill and
suffering, the wish to work in client service, in interaction with people, and the idea of being
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Salminen-Tuomaala, M., & Herttuala, N. (2022). What Factors Influenced Students’ Decision to Choose Nursing? European Journal of Applied
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URL: http://dx.doi.org/10.14738/aivp.105.13237
suited for the profession had clearly been the most compelling motivators for the students. The
clear majority of them, over 84%, reported that their wish to help the ill and suffering had
influenced their decision to apply very much or rather much (mean 1.9; median 2.0). Similarly,
nearly 82% of the students found that their desire to have a job that involved social interaction
and client service had affected their decision very much or rather much. In addition, the
majority of the participants (74.5%) seemed to believe in their skills to support people; this
belief had affected their decision to apply very much or rather much.
In contrast, professional prestige or other people’s opinions had not much affected the students’
decision to apply to the nursing program. Less than one in five (19.1%) respondents thought
that appreciation for the nursing profession had contributed to their decision to apply.
Interestingly, only 5.4% of the students found that the image of nursing in social media had
affected their decision to choose nursing.
The family’s opinion had been of some importance to just 13% of the participants, their friends’
career choices had been of significance to even fewer (3.3%; Likert scale mean 4.4; median 5).
Having familiar people sharing their experiences of nursing work had impacted on few students
(9.7%). Student counselors had not played a significant role either; their opinion had affected
the decision-making of 7.5% of the participants. Although most nursing students had been
motivated by the desire to help and alleviate suffering, less than one third of them (27.7%)
reported earlier experience of helping family members or other significant others as factors
affecting their choice of profession. Less than a fourth of them (23.6%) found that having
witnessed illness in the close ones had influenced their decision.
The currently favorable employment situation can be considered an extrinsic factor that had
most significantly affected the students’ decision to choose nursing as a profession. Nearly 47%
of the participants agreed that the employment situation had influenced their decision very
much or rather much. Compared to most other items in the questionnaire, there was more
variation in the responses to this question; 19.2% of the respondents found the employment
situation had affected their decision to apply rather little and 11.7% reported it had affected
their decision very little (mean 2.8; median 3).
DISCUSSION
For the majority of the 94 nursing students involved in this quantitative study, intrinsic factors
- the desire to help, work in client service, interaction with people, and being suited for the
profession - had clearly been the most compelling motivators for applying for the program. This
finding is in agreement with a great deal of previous literature [13, 22] and it reflects the
altruistic core values of nursing [17].
Unlike in some earlier research [19], prior healthcare exposure had not been an important
factor for the students in this study when choosing nursing as a career. Experiences of seeing a
family member in a patient’s role had had little effect on their choices. On the other hand, a few
participants were already practical (enrolled) nurses upgrading their education to the tertiary
level. Their motivation may have been based on the desire to grow in their career and take on
more responsibility.
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Secondly, in contrast with several other studies [18, 21], the students’ choice to study nursing
had not depended on role models from friends or families. It is possible that in an individualistic
country like Finland, students tend to rely less on the family’s opinion. In addition, the current
generation Z (born between the mid-1990s and 2012), as the previous generation of
Millennials, may be more independent than earlier generations. Their attitudes, beliefs, social
norms, and behaviors are likely to require changes in education and practice for many years
[29] and make it necessary to explore what meaningful work involves for these new
generations. On the other hand, some of the participants in this study were mature students
with earlier education and work experience. These students had probably already passed the
phase of emerging adulthood and the most intense period of identity development and were
not much influenced by family and friends.
Among what can be considered extrinsic factors; job security, or the favorable employment
situation, had significantly affected the students’ decision to choose nursing as a profession. The
same finding has been reported in earlier research as well [21]. The students had not sought
social prestige when selecting nursing as a profession. The likely interpretation is that, as in
earlier research [22] students were well aware of the relatively low status of nursing, but it did
not stop them from entering the program. A preliminary analysis of the qualitative data of this
study supports this idea.
Somewhat surprisingly, in this study the social media had had little effect on the students’
decision to apply to a nursing program. Earlier research supports the notion that social media
can be useful in increasing the attractiveness of nursing organizations [34-37]. On the other
hand, the public image of nursing is rather diverse. It is still to a great extent based on
misconceptions and stereotypes and does not meet the professional image of nursing [38]. It
may be carefully concluded that individuals influenced by negative comments in the media had
not sought to enter the nursing program. More research is required on the effect of negative
publicity on the recruitment of nursing students.
The fact that the study was conducted in a single University of Applied Sciences in one country
can be considered a limitation. The response rate, however, was adequate (56%) and the
number of participants relatively high (94). The results can be generalized nationally and
possibly internationally.
CONCLUSION
It is a positive finding that the desire to help people and alleviate suffering is still the most
compelling motivator for entering the nursing profession. Such intrinsic motivation can
counteract dissatisfaction and carry nurses through difficult times. It is also important that
nursing students feel suited for interaction with people; interaction skills are an essential part
of high quality work with clients. Based on the results of this study, it can be carefully suggested
that nursing students are well aware of factors that affects their suitability for the profession.
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URL: http://dx.doi.org/10.14738/aivp.105.13237
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