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00006247-201104000-0000500006247_2011_42_19_rambur_perception_4report< 86_0_7_2 >Nursing Management (Springhouse)© 2011 by Lippincott Williams & Wilkins, Inc.Volume 42(4)April 2011p 19–24EXTRA Young adults' perception of an ideal career: Does gender matter?[Feature: Recruitment & Retention Report]Rambur, Betty PhD, RN; Palumbo, Mary Val DNP, APRN; McIntosh, Barbara PhD; Cohen, Judy PhD, RN; Naud, Shelly PhDAt the University of Vermont in Burlington, Vt., Betty Rambur is a professor of nursing in the College of Nursing and Health Sciences. Mary Val Palumbo is the director of the AHEC Office of Nursing Workforce, Research, Planning, and Development. Barbara McIntosh is a professor in the School of Business Administration. Judy Cohen is a professor in the Department of Nursing, College of Nursing and Health Sciences. Shelly Naud is a biostatistician in Medical Biostatistics & Bioinformatics in the College of Medicine.Support for this research was received from HRSA Research Focused Initiative #R1C RH03426-01 "Vermont Health Workforce Supply/Demand Monitoring System."For years, gender diversity in nursing has been recognized as being as important as racial and ethnic diversity in providing quality care for our population.1 Men, nevertheless, remain decidedly underrepresented in the nursing workforce. Despite the recession-related downturn in some healthcare markets, the magnitude of the projected nursing shortage—coupled with the complexity of the care provided by nurses—suggests that it's valuable to recruit from the full potential talent pool to best serve our nation's health needs.Figure. No caption available.This study's aim was to better understand similarities and differences by gender among young adults' perception of an ideal career and their perception of nursing. This approach assumes that career choices, at least in part, are influenced by the perceived fit between a hypothetical ideal and potentially available career choices. The overall objective is to inform the development of evidence-based career recruitment strategies that are appropriately targeted to both men and women.BackgroundCareer choice and gender. Two factors have been consistently theorized to influence traditional career choices: prescribed gender roles and vocational interests.2 Gottfredson, for example, argued that early gender role socialization shapes interests, which in turn circumscribes one's range of acceptable career alternatives.3 Further, a mismatch between college students' work goals and perceived potential goal achievement may explain differences in interest and career choice. Compared with men, for example, women in one study reported interpersonal work goals more frequently and high pay and work status work goals less frequently.4 Similarly, in a study of medical students choosing a specialty, men were more likely to identify technical challenge, earning potential, and prestige as important qualities in a specialty; women were more likely to identify residency conditions, part-time work, and parental leave availability.5 It's argued that cultural beliefs about gender bias individuals' perceptions about their own competencies and goals in various career relevant tasks. Thus, to the extent that individuals act on gender-differentiated perceptions when making career decisions, men and women move in substantially different career directions.6It has also been suggested that men and women approach career decision making differently and that these differences are magnified when considering gender nontraditional careers.7 Men are often discouraged from entering female-dominated careers, which are typically perceived as lower in status and salary.2,8,9 Further, men who express interest in or choose nontraditional occupations may lack support or risk being devalued for engaging in "gender inappropriate" behavior.2,9 Certainly, gender-based views of nursing remain, and this has consequences. Barriers that exist for men as they pursue nursing careers need to be addressed in both education and practice settings for both recruitment and retention efforts to succeed.10–13Image of nursing. Many sources have pointed to a less than attractive image of nursing as a barrier to recruitment into the profession.14–20 In response, improving the image of nursing in the eyes of adolescents and young adults has been recommended as a necessary step toward replacing retiring nurses. Progress has been made in this area in the last decade as nursing schools have gone from being under-enrolled to turning thousands of students away.21,22 National campaigns are having a measurable impact. A national sample of 496 nursing students found that they've received the message that nursing is a good career for men, for people who have academic ability, and those who want a secure job.23 This study also acknowledged the importance of information and advice from practicing nurses to provide a positive influence.Recruiting men into nursing. Despite the fact that progress has been made nationally in recruiting men into nursing, progress has been painfully slow.24 The female-male mix in this study's setting, for example, has remained constant for the last 6 years, with men constituting less than 7% of the RN population.25 Further analysis of the characteristics of male nurses revealed that they tend to enter nursing as a second career and, when compared with women, prefer the following settings at statistically significant levels: critical care, emergency/trauma, OR, and psychiatric/mental health.11,26,27These findings, with the notable exception of the psychiatric-mental health setting, are similar to an Australian study, which found that male nursing students intended to work in specialty areas such as emergency nursing, OR nursing, and intensive care.26 Similarly, a U.K. study found gender and gender role orientation to be predictive of sex-typed career aspirations.11 A Hong Kong study of 1,246 Form 6 students—28% of whom reported an interest in nursing—found an association between reported interest in nursing and, among other variables, gender and mother's occupation.28 Together, these findings suggest that targeted marketing of the profession to young men may require distinctive elements.The challenge of achieving adequate representation of men in nursing isn't just that of recruiting men into a workforce that has traditionally been dominated by women. Instead, deeply held cultural values and patterns of behavior are often imbedded in invisible ways. Thus, a better understanding of the similarities and differences between male and female perceptions of an ideal career, and an appreciation of nursing, are viewed by the authors as an important next step toward broadening the appeal of the profession across diverse groups.MethodsThis survey design study was a secondary analysis, by gender, of a larger study focusing on six health careers.29 The convenience sample of young adults (n = 116, 71 women and 45 men), age 18 to 24, attended community events, such as county and local job fairs in one U.S. metropolitan statistical area and two adjacent rural counties. Data were collected between January 2005 and September 2005. Young adults were offered a chance to win a handheld personal computer in exchange for completing the survey. There was no discussion of healthcare careers before administration of the survey.The instrument used was developed by May, Champion, and Austin and used with permission.30 This tool queries respondents on 17 parallel items and uses language appropriate for a nonprofessional audience. For each item, respondents were asked to evaluate, using a scale of one to five, the importance of a particular attribute to the ideal career; a parallel question asked the importance of this attribute to nursing. The instrument has been used in multiple studies31–33 and tested with different groups, including college, high school, and middle school students, and parents, teachers, guidance counselors, and school nurses.Reliability and validity were previously established, with coefficient alpha ranging from 0.81 to 0.84; content validity was established using a panel of experts. Data were analyzed with descriptive statistics and the Wilcoxon and Bonferroni adjusted paired t-tests to accommodate multiple comparisons. The study was reviewed by the Institutional Review Board at the University of Vermont before implementation. Informed consent was obtained from each individual before administration of the survey.ResultsWomen and men identified similar key career attributes; however, their rank order was slightly different. Women identified "have respect," "am appreciated," and "make decisions" as the top elements of an ideal career. For men, "job security" and "am appreciated" were the top two attributes of an ideal career, followed by a three-way tie among "have respect," "have a college degree," and "work very hard." In both the male and female cohorts there was consistency between nursing and the ideal career on six attributes. These were job security, knowledge level required ("know a lot"), use of intellect ("use brain"), care for people, power, and leadership. It's important to note, however, that power and leadership weren't highly ranked as elements in an ideal career. The perception of nurses as having only modest power and leadership was matched by power and leadership being less important attributes of an ideal career.Both men and women perceived nursing as significantly different from their ideal career (Bonferroni adjusted alpha of < 0.0028). Nursing was perceived as being too busy, requiring too little decision making, and yielding too little respect. In addition to these results for the whole sample, statistically significant differences between men and women emerged. Women perceived nursing as using more technology, requiring more work with their hands, and being in a less safe workplace than their ideal. These differences between an ideal career and nursing weren't statistically significant for men. Instead, men perceived nursing as being less than their ideal in the areas of "having a college degree" and "making a lot of money." (See Table 1.)Table 1: Significant differences in perceptions of nursing and the ideal career for men and womenThe patterns among these differences are nuanced in important ways. One of three differences for women described above, for example, wasn't because men and women perceived nursing differently, but instead because they perceived their ideal career differently. For men, using technology was high among the attributes of an ideal career; this wasn't true for women. Thus, because both men and women ranked nursing high on this attribute, nursing was more consistent with the ideal career for men than women. In a similar manner, men and women ranked nursing similarly in the area of "requires a college degree." Men, however, ranked this attribute very highly as an attribute of an ideal career, and nursing fell below this ideal.DiscussionOverall, when examining individual key attributes, there were fewer statistically significant differences between perceptions of an ideal career and perceptions of nursing for men than there were for women. This implies that nursing isn't at odds with what men value in a career, but instead that recruitment into the profession continues to be impacted by social context. Optimal recruitment, therefore, might overtly address such issues with a "Think nursing isn't for you: Think again!" type campaign, highlighting diverse roles, genders, ages, and races to enable a correspondingly diverse population to envision themselves in nursing. At the same time, competition for nursing slots in postsecondary education is currently ferocious; marketing campaigns must realistically balance the need to engender interest across diverse populations with the magnitude of the challenges many high ability applicants face when attempting to access preparation programs.Some elements of an ideal career that exist in nursing, such as job security, knowledge requirements, and caring for people, are perceived similarly in an ideal career by both men and women in this study. Successful marketing to young adults will illustrate these valued attributes. At the same time, job security is a mercurial element in today's society. Current economic realities have slowed the retirement of some nurses, and healthcare markets have softened in some regions of the country due to potential patients' loss of employer-based insurance, delay of elective procedures, and shifts in Medicaid funding. Thus, it's essential that marketing campaigns stress that it's vital to want the work itself, not just as a means to economic stability.Realistic career marketing must underscore the complexity and depth of nursing decision making, as well as the real challenges, demands, and disappointments of contemporary professional practice. Perceptions of the work environment do indeed trickle down to potential new recruits. It therefore behooves organizations to create work environments that match the ideal of those whom they wish to recruit. This is particularly important for attributes that have been recognized in other studies as key elements in highly functioning organizations, such as autonomy.34 Nonetheless, successful marketing must correlate with reality if it's to resonate with veracity and authenticity. Career "negatives" identified to exist in nursing, such as busyness, lack of respect, and too few financial rewards, must be addressed in the workplace before marketing can successfully—and ethically—redress these images.Our study found that women value technology and hands-on work less than men. A study of Canadian students found similar results.35 STEM (Science, Technology, Engineering, and Math) emphasis in K-12 education—initially designed to attract women into traditionally male-dominated fields such as engineering and math—may assist nursing recruitment of men, given that technology and hands-on work are desirable elements for men and found in most nursing practice. At the same time, nursing recruitment can legitimately underscore the multiplicity of options within nursing practice, options that range from a high-touch to a high-technology spectrum. Nursing may particularly benefit from public images that capture the range of roles. Again, such marketing would make it possible for anyone to see themselves within the face of nursing.The finding that women perceived the safety of the nursing workplace to be significantly less than the ideal career is curious and warrants further exploration. This study wasn't designed to explore the rationale behind the perceptions, so it's unclear if the concern stems from perceived infectious disease, horizontal violence, workplace injury, or some other element(s). These findings, however, are similar to a previous study in the middle school age group in which the female cohort indicated a statistically significant difference between an ideal career and nursing in the area of a safe workplace; nursing was perceived as less than the ideal career. Such a difference wasn't evident in the male cohort.31 Safety is a fundamental human need, and together these findings point to an important area for future research.In aggregate, these findings also support the value of empirically-based, niche-sensitive recruitment strategies because perceptions and values of men and women differ, and these differences matter. Further studies designed to better understand the career perceptions of other underrepresented groups in nursing, such as ethnic minorities, can enable the development of strategic career recruitment campaigns. Similar studies across cultures, geographic regions, and population densities would expand these findings and enhance the potential for evidence-based recruitment.Implications for organizational leaders and managersThis study identified cohort similarities and differences, by gender, in young adults during their career selection developmental stage. Because these perceptions are reinforced or undermined by the actual workplace setting, these findings may have implications for health service leaders and managers. Specifically, as critical as the "between-group" differences identified in this study remain, "within-group" differences likely exist, and further complicate the mentoring and workforce development responsibilities of frontline managers.Savvy organizations, specifically those that want to maximize the potential contributions of each and every member of the workplace community, will enable managers to more easily be aware of gender differences. At the same time, managers should remain cognizant that individuals within gender cohorts may have additional, divergent, or unique needs and values. Taken as a whole, these similarities and differences are critical; employees whose work can align with their deepest values and perceived best self are more likely to remain committed to the organization and, importantly, the larger work of the profession.Extrapolating from these findings for the benefit of nurse managers and leaders, the following Continuous Development Protocol is recommended for implementation: 1. Formal training for all nurse managers on the role of gender, values, and self perception in workplace effectiveness and satisfaction. 2. Values-centric annual reviews and career planning. Specifically, the nurse and nurse manager meet at the time of the initial hire and during the annual review to survey the individual's:(a) career values and hope for life's work(b) job aspirations and job learning goals for the upcoming year(c) career aspirations and career learning goals for the upcoming year.In these one-on-one sessions, special note is made of the individual's values, perceived strengths, and growth edges, as well as the particular opportunities and challenges in the immediate job setting. Such conversations may lead to surprising new connections and insights for the organization and the individual, as well as the opportunity to align unique aptitudes and abilities with organizational need. Moreover, an emphasis on job and career planning is essential, as the most talented nurses of all genders will seek new challenges toward continuous self-development and progressively more complex self-mastery. 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