The General Perceptions of Career Choice of Nursing and Related Factors among Secondary School Students

Introduction:

The nursing shortage is a global problem and continues to grow with nursing recruitment and retention being recognized as global priorities. There is currently a shortage of medical staff in healthcare, and this is especially acute in nursing. A review of the literature provides information on several key factors influencing career choice and perceptions toward nursing as a future profession among students 1.

Healthcare sectors in Saudi Arabia are currently undergoing major changes as a result of population and economic growth as well as patient-related factors such as health awareness and prevalent diseases. Many of these amendments stem from the Kingdom’s Vision 2030, which proposes to improve the quality of healthcare and education to meet national needs and international accreditation standards (Saudi Arabia Vision 2030& 2016) 2 .

The causes of the nursing shortage in Saudi Arabia, particularly the shortage of Saudi nurses, is a multifaceted problem. Thus, it is unlikely that there can be a single solution. Saudi nursing problems reflect the global shortage of nurses, which is an external problem that Saudi Arabia's policies and practices cannot control. To counteract the nursing shortage and ensure the provision of nurse practitioners, educating the potential nursing workforce is critical. Nursing is a valuable, noble and honourable profession because the nurse cares about helping sick people. These descriptions emphasize the necessity of nurses in everyone's life, whether healthy or sickl. Hence, policymakers should strive for sustainability among the nursing profession 3.

Nursing has remained a popular career choice for both young and old students entering university. The choice of nursing profession may be related to internal factors such as admiration for the profession and the presence of a relative working in healthcare 4. Positive attitudes towards the nursing profession among high school students may help increase the number of applicants in nursing schools to fill the gap in the nursing staff shortage at the national and global levels.

The negative image of the nursing profession is not an innate behaviour and has arisen from multidimensional factors. To address these issues, nurse managers and other stakeholders must devise a specific strategy to overcome the negative image of nurses toward their profession 5.

Understanding the factors that influence people in selecting nursing as a profession has important implications for healthcare today 6.

Nursing students make their career decisions through a range of personal interests in health care, prior health care exposure, academic performance, job prospects, practical factors, and social influences that influence their desire to help others 1. Attitudes towards the nursing profession can improve due to the good work and good compensation of nurses and nursing assistants 7. Understanding how these future nurses choose nursing as a career option is of critical importance to the profession with implications for both recruitment and retention 8.

Nursing applicants' perceptions of nursing education do not reflect that of a modern nurse 9. Nursing is the cornerstone of the health care system and the heart of the health system; medicine is the brain of the health system. They make up the largest proportion of the healthcare workforce anywhere in the world 10. Several previous studies support the idea that the concept of the nursing profession guides the choice of nursing as a profession 11.

Therefore, we believe that studying and exploring perceptions and attitudes towards the nursing profession should include all segments of society—especially secondary school students and the final stage of secondary school because these students form their desires and tendencies toward the specialization. To identify these perceptions, we conducted this study to provide recommendations that help guide the development of strategies for the competent authorities to increase Saudi society’s attraction towards the nursing profession.

To the best of our knowledge, there are few or no studies regarding secondary school students’ perceptions toward nursing in Saudi Arabia. As a result, this study evaluated the general perceptions and attitudes of secondary school students regarding nursing as a career choice in upcoming university education in selected secondary schools in Najran, Saudi Arabia.

Materials and Methods:

This was a cross-sectional study conducted in secondary schools in Najran City involving third-level students of both sexes who agreed to participate in the study during year 2022. The study utilized convenience sampling, and 340 students agreed to participate in the study and complete the questionnaire. A structural questionnaire was used as a tool to collect data from participants. The questionnaire consisted of two parts: The first part included sociodemographic data, and the second part was adopted from similar previous research work 11–14 including perceptions of the nursing career and influencing factors. Participants answered the items using a three‑point Likert scale with (1 = agree ; 2 = disagree; 3 = neutral).

The study began after getting approval from the ethical committee of the health research centre. Following that, a letter was sent to the Department of Education in the Najran region requesting approval from the university, and after approval, the Department of Education in the Najran region sent a letter to targeted secondary schools in the city of Najran.After clarifying the purpose of the study, the participants who agreed to participate in the study were informed about the objectives of the study and their voluntary participation, verbal consent was taken from them, including students under the age of 18 and their parents, and they were given an email to communicate with the principal investigator to answer any questions about the study. The data they provided were treated with confidentiality. The survey was distributed through media via links to Google Forms and distributed to secondary schools in Najran city. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 23.0. Sociodemographic variables were analysed using descriptive statistics. The correlation between perceptions was analysed using chi-square or χ2 test. P < 0.05 was considered as statistically significant.

Results

Table 1. Demographic characteristics of the study population reveals, there were 340 students from third-level secondary schools who participated in the survey. Their average age was 18.47 years (Std. Deviation 2.489 years). Of these, 145 (42.6%) were male and 195 (57.4%) were female. There were 293 (86.25%) Saudi and 47 (13.2%) non-Saudi nationals. The respondent fathers' level of education showed that 20 (5.9%) were illiterate, 59 (17.4%) had primary education, 133 (39.1%) had secondary education, 92 (27.1%) had university/college level, and the remaining 36 (10.6%) were graduates or postgraduates (MSc. PhD). The respondent fathers included 201 (59.1%) government employees, 18 (5.3%) private employees, 25 (7.4%) with private work, 26 (7.6%) unemployed, and 70 (20.6%) retired. The respondent mother’s level of education showed that 58 (17.1%) were illiterate, 89 (26.2%) had primary school level, 100 (29.4%) had secondary school level, 79 (23.2%) had university/college level, and the remaining 14 (4.1%) were graduates or postgraduates (MSc. PhD). The respondent mothers’ occupation showed that 83 (24.4%) were government employees, 5 (1.5%) were private employees, 145 (42.6%) were unemployed, and 107 (31.5%) were housewives. There were 117 subjects (34.4%) who answered ‘yes, they will select nursing as their future career.

Table 1. Demographic characteristics of the study population (n=340).
Characteristic		Frequency	(%)
Gender	Male	145	42.6
Female	195	57.4
Nationality	Saudi	293	86.2
Non-Saudi	47	13.8
Fathers' level of education	Illiterate	20	5.9
Primary	59	17.4
Secondary	133	39.1
University/ college	92	27.1
Graduate	36	10.6
Fathers' occupation	Governmental Employee	201	59.1
Private Employee	18	5.3
Private work	25	7.4
Unemployed	26	7.6
Retired	70	20.6
Mothers' level of education	Illiterate	58	17.1
Primary	89	26.2
Secondary	100	29.4
University/ college	79	23.2
Graduate	14	4.1
Mothers' occupation	Governmental Employee	83	24.4
Private Employee	5	1.5
Unemployed	145	42.6
House wife	107	31.5
Training course in school on how to choose the appropriate major to study at the university	Yes	82	24.1
No	258	75.9
Did you think you will select nursing As a future career choice?	Yes	117	34.4
No	77	22.6
Maybe	146	42.9

Table 2. Regarding Career choice in coming university education it illustrates that more than third 131(38.5%) Nursing followed by 17 in medicine (20.9%), 17 in health sciences (medicine or nursing, dentistry, radiology, or pharmacy) (5.0%) , 26 in engineering (7.6%), 17 in (5.0%), two in accounting ( 0.6%), 18 in psychology (5.3%), 21 in business administration and economics (6.2%), 16 in education (mathematics, physics) (4.7%), and the remaining 21 had not yet decided but will in the upcoming university term

Table 2. Career choice in coming university education (n=340).
Response	Frequency	Percent
	Medicine	71	20.9
Nursing	131	38.5
Health sciences (medicine or nursing, dentistry, radiology, pharmacy)	17	5.0
Engineering	26	7.6
Law	17	5.0
Accounting	2	.6
Psychology	18	5.3
business administration, economic	21	6.2
Education (Mathematics, Physics)	16	4,7
I don’t decide yet	21	6.2
Total	340	100.0

Table 3. Regarding the factors that influence the choice of university major, more than the half were influenced by future ambition 188 (55.92%) followed by 60 (17.6%) who stated that it does not matter and they would accept any specialty. Another 21 (6.17%) respondents stated that they will choose the specialty that their friends will choose.

Table 3. Factors affecting your selection of university specialty (n=340).
Response	Frequency	Percent
	What parents want	14	4.1
My future ambition	188	55.92
I will choose the specialty that my friends will choose	21	6.17
Doesn’t matter; I will accept any specialty	60	17.6
I will choose the major based on the lessons I have received at school	2	.6
I will choose any specialization that helps me with the requirements of living	4	1.2
I will choose the specialization after reading about the desired specialization in the labour market	14	4.1
What parents want me to be in the future + My future ambition	33	9.7
I will choose any specialization that helps me with the requirements of living + I will choose the specialization after reading and learning about the desired specialization in the labour market	4	1.2
Total	340	100.0

Table 4. Regarding Perceptions of nursing, the results showed positive perceptions of nursing. Most participants (n=205; 60.3%) agree that the nursing profession is a profession to help others. Most participants (n=26; 76.8%) agreed that nursing is an attractive job and a good discipline. In addition, 229 (67.4%) agreed that nurses earn a good salary, There were 199 (58.5%) participants who agreed that studying nursing implied that it was easy to get a job. There were 271 (79.7%) who agreed that nurses are respected and valuable by society. Furthermore, 146 (42.9%) disagreed that nursing is primarily for women.

Table 4. Perceptions of nursing profession (n=340).
My desire to help others
Response	Frequency	%	Mean	SD	Results
agree	205	60.3	1.5265	71388	Agree
natural	91	26.8
disagree	44	12.9
Nursing is an attractive job and a good discipline
agree	261	76.8	1.2853	.55740	Agree
natural	61	17.9
disagree	18	5.3
Nurses earn a good salary
agree	229	67.4	1.4206	.65818	Agree
natural	79	23.2
disagree	32	9.4
Studying nursing makes it easy to get a job
agree	199	58.5	1.5412	.70903	Agree
natural	98	28.8
disagree	43	12.6
Nurses are respected and valued by society
agree	271	79.7	1.2706	.57762	Agree
natural	46	13.5
disagree	23	6.8
Nursing is primarily for women
agree	89	26.2	2.1676	.81549	Disagree
natural	105	30.9
disagree	146	42.9

Discussion:

There were 340 students from third-level secondary schools who participated in the study. Their average age was 18.47 years (Std. Deviation 2.489 years). Of these, 145 (42.6%) were male and 195 (57.4%) were female. There were 293 (86.25%) Saudi and 47 (13.2%) non-Saudi nationals. Regarding the factors that influence the choice of university major), more than the half were influenced by future ambition 188 (55.92%) followed by 60 (17.6%) who stated that it does not matter and they would accept any specialty. This result is consistent with another study 15, which suggests that students’ personality factors influence the significance of other predictors of career choice. Our results showed less influence by school classes in terms of the desired specialty or how to select a career in university education (n=2; 0.6%). In addition, 33 (9.7%) respondents stated that they selected a career according to what their parents wanted them to be in the future and their future ambition. This result consistent with prior work 16, which concluded that students’ interaction with family members on career choices or options are more important than advice from peers. The result does not support other work concluding that the parents’ image of nursing was the factor with the least influence 17, 18.

The results showed positive perceptions of nursing. This result consistent with a study finding positive perceptions about nursing in Bahrain 19. Most participants (n=205; 60.3%) agree that the nursing profession is a profession to help others. This is in line with a study 20, 21 concluding that motivation, such as the opportunity to help others, was the primary factor that influences students to choose nursing. Another study 22 concluded that the major factors contributing to enrolling in nursing were the opportunity to care and help needy people. Most participants (n=26; 76.8%) agreed that nursing is an attractive job and a good discipline. In addition, 229 (67.4%) agreed that nurses earn a good salary, which is consistent with prior work [12]. There were 199 (58.5%) participants who agreed that studying nursing implied that it was easy to get a job. This result agrees with literature 23 which concludes that students preferred nursing due to the high employment possibilities in this field. There were 271 (79.7%) who agreed that nurses are respected and valuable by society consistent with the literature 24. Furthermore, 146 (42.9%) disagreed that nursing is primarily for women. This result is in line with a study 11 that showed that most students disagreed that nursing is a job for females.

The study revealed a significant difference between career choice in university and sociodemographic characteristics (gender, nationality, father’s level of education; p-value ≤ 0.05). This result is consistent with the literature 25, which concludes that there is no significant difference in the relationship between gender and reasons for studying nursing. There is an insignificant difference between the choice of nursing as career and father’s occupation, the mother’s level of education, and mother’s occupation (p-value ≥ 0.05). There is also an insignificant difference between a choice of nursing as a career and training course in school. This result is not similar to prior work 25 that concluded that factors were significantly rated higher by respondents with previous training compared to those without training. The results showed statistically significant differences (p-value ≤ 0.05) between choosing a nursing career and all factors that affect the selection of university specialty (what parents want me to be in the future; my future ambition). Choosing nursing as a career had a significant p-value ≤ 0.05, with the perception of nursing (nursing is a job to help others, nursing is an attractive job, nurses earn a good salary, and nursing is primary for women).

Conclusion:

Overall, the students who participated in the research showed positive perceptions toward the nursing profession. Many factors are found to influence these perceptions. Factors that influence the choice of university specialty include future ambition but not parents and school lessons. In general, nearly 60% of participants considered nursing to be a profession that helps others; three quarters considered nursing to be an attractive job and a good discipline. Nearly 70% agreed that nurses earn good salaries; approximately 80% of respondents believed that nurses are respected and valued by society; less than half disagree that nursing is primarily for women.

“The authors have no conflicts of interest to declare.”

Author 1 and author 2 Study design and author^1,2,3 collect data. Author 1 and author 2 analyzed the data and prepared the manuscript. All authors approved the final manuscript.

Data Availability Statement

The data that support the findings of this study are available on request from Author 1 OR the corresponding author.

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