Choosing nursing: becoming, staying, flourishing


Health care is facing a crisis with the global shortage of nurses. In Western countries this is accentuated by nurses’ ageing demographic profiles and changing opportunities for career recruitment and advancement, occurring alongside escalating demand for nursing care to service increasingly complex healthcare interventions and to support ageing populations. Nursing recruitment and retention, always important topics, are increasing in priority. Three questions are key:

  • Why do people choose a career in nursing?
  • Why do nurses stay (or leave) nursing?
  • What can the profession do to optimize both choices?

These topics are reflected in nursing policy and strategy internationally and comprise a crucial research agenda. Articles in this edition contribute to this.

Choosing nursing: in this edition Eley et al. (2012) and Jirwe and Rudman (2012) examine the personality traits and reasons nurses give for choosing a career in nursing. Both reveal a mix of pragmatism and practicalities with caring and altruism, indicating the notion of nursing as vocation has not disappeared despite its development as an academic discipline, financial crises and employment insecurity. This enables a better emphasis for recruitment strategies on aspects which resonate with potential nurses.

Staying in nursing: over time this question has moved from features such as pay and conditions to a wider focus on positive and negative, intrinsic and extrinsic influences on job satisfaction. Taking different approaches to theory development but both building on established international work including by members of the author group, in this edition Carter and Tourangeau (2012), and Cummings and Cowden (2012) identify common factors including psychological engagement and organizational commitment, autonomy and empowerment, perceived availability of career development opportunities, leadership/management practices and being able to achieve work-life balance as significant to intention to remain in nursing. With both individual and workplace characteristics influential to retention decisions, Leggat et al. (2012) demonstrate that, in Australia, the negative effects of emotional labour on burnout can be reduced by perceived high performance work systems, characterized by extensive training, information sharing, teamwork and decentralized decision-making. Furthermore, such work systems mediate the relationship between these characteristics and intention to leave. Intention to leave in the context of a Scottish telephone advice service (Farquharson et al. 2012) is significantly predicted by work-family conflict; for American nurse faculty, by organizational commitment including perceived organizational support and developmental experiences (Gutierrez et al. 2012). One factor consistently flagged as influential to the context and culture of care is that of its leadership, and leadership style. In community nursing teams (Cameron et al. 2012) show that practices associated with transformational leadership result in practitioners being regarded as good leaders.

What do we glean from all this? Although the balance of relative advantage and disadvantage changes between settings and countries, these are differences of degree rather than substance. There is overall consistency in these findings, both in terms of what is found and what is indicated for strategies to promote recruitment and retention. ‘One size does not fit all’ but much can be done by organizations to create environments which engage nurses with their work, facilitate development of healthy work systems and patterns, provide support for aspects of the role which are taxing, encourage professional development and role advancement. More can be done to promote this as the image of nursing. Examples such as the Magnet programme show that real advantage can be gained: surely now it is time for widespread application of what we have learned.