Open Collections

UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

A descriptive study of nursing refresher course candidates MacLean, Sally Anne 1981

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-UBC_1981_A5_7 M23.pdf [ 4.12MB ]
Metadata
JSON: 831-1.0095188.json
JSON-LD: 831-1.0095188-ld.json
RDF/XML (Pretty): 831-1.0095188-rdf.xml
RDF/JSON: 831-1.0095188-rdf.json
Turtle: 831-1.0095188-turtle.txt
N-Triples: 831-1.0095188-rdf-ntriples.txt
Original Record: 831-1.0095188-source.json
Full Text
831-1.0095188-fulltext.txt
Citation
831-1.0095188.ris

Full Text

A DESCRIPTIVE STUDY OF NURSING REFRESHER COURSE CANDIDATES by SALLY ANNE MACLEAN B.Sc.N., The University of B r i t i s h Columbia, 1975 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING i n THE FACULTY OF GRADUATE STUDIES (School of Nursing) We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA APRIL 1981 © S a l l y Anne MacLean, 1981 In presenting t h i s thesis i n p a r t i a l f u l f i l m e n t of the requirements for an advanced degree at the University of B r i t i s h Columbia, I agree that the Library s h a l l make i t f r e e l y a v a i l a b l e for reference and study. I further agree that permission for extensive copying of t h i s thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. I t i s understood that copying or p u b l i c a t i o n of t h i s thesis for f i n a n c i a l gain s h a l l not be allowed without my written permission. The University of B r i t i s h Columbia 2075 Wesbrook Place Vancouver, Canada V6T 1W5 Date DE-6 (2/791 i i ABSTRACT The study had two purposes. The f i r s t purpose was to describe the c h a r a c t e r i s t i c s of graduate nurses who had expressed i n t e r e s t i n a refresher course f o r graduate nurses. The second purpose was to deter-mine the extent to which these nurses were a p o t e n t i a l source of nurse manpower supply. Survey methodology, u t i l i z i n g a mail-back questionnaire developed by the in v e s t i g a t o r , was selected as the research approach. The questionnaire was completed by 199 nurses who had placed t h e i r names on the mailing l i s t f o r a refresher course for graduate nurses at one post-secondary educational i n s t i t u t i o n located i n a large metro-p o l i t a n area. Analysis indicated that graduate nurses who express i n t e r e s t i n a refresher course are not s i m i l a r , as a group, to the en t i r e population of in a c t i v e nurses. Rather, they c o n s t i t u t e a population of both i n a c t i v e and employed nurses. Nurses i n the study sample were older, had older c h i l d r e n and had graduated e a r l i e r than had been found i n previous studies of inactive nurses. It was concluded that the extent to which nurses who express i n t e r e s t i n a refresher course represent a p o t e n t i a l source of nurse manpower supply i s less than might be expected on the basis of numbers alone. F o r t y - s i x nurses (23.1 percent) were employed as reg i s t e r e d nurses when they completed the questionnaire. Of the 153 respondents who were ina c t i v e i n nursing, a majority (66 percent) indicated they planned to resume active status as nurses upon completion of a refresher course. Most, (57.4 percent) would prefer part-time employment and schedules that provide for a minimum of c o n f l i c t with family a c t i v i t i e s and r e s p o n s i b i l i t i e s . The study was l i m i t e d by a low response rate and by an absence of follow-up of non-respondents but, given these l i m i t a t i o n s , the r e s u l t s have implications for nursing education and for nursing administration. iv TABLE OF CONTENTS Abstract 1 1 List of Figures V 1 List of Tables v i i Acknowledgements i x CHAPTER I INTRODUCTION Context of the problem 1 Statement of the purpose 6 Objectives of the study 6 Definition of terms 6 Limitations 7 Organization of the study report 8 II REVIEW OF RELATED LITERATURE Introduction 9 Characteristics of inactive nurses 11 Employment patterns of women 15 Factors affecting employment of nurses 17 Refresher courses for graduate nurses 19 Summary 20 III METHODOLOGY Introduction 22 Selection of the Sample • 23 Development of the instrument 23 Pretesting 24 Final Questionnaire 27 Reliability and validity of the instrument 27 Administration of the questionnaire 27 Response rate 28 Data analysis 28 V CHAPTER IV FINDINGS AND DISCUSSION Introduction 30 Demographic, Education and Work Experience Characteristics of Respondents , , 31 Reasons for Taking a Refresher Course , 39 Future Employment in Nursing 41 Advantages and Disadvantages of Working as a Registered Nurse 42 Date of Employment 45 Location 46 Cli n i c a l Preference 48 Restriction on Employability . 50 Alternate Plans 50 Comparison of Sub samples 53 Employed Nurses 53 V SUMMARY AND CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS Summary 55 Conclusions 57 Implications 58 Implications for Nursing Education , 58 Implications for Nursing Administration 60 Recommendations for Further Study 61 BIBLIOGRAPHY 63 APPENDICES A Letter of Agreement 69 B Questionnaire 71 C Covering Letter 84 D Follow-up Letter 86 E Comments 88 F Chi-Square Analyses of selected variables -inactive nurses 92 v i LIST OF FIGURES FIGURE 1 LIST OF VARIABLES 25 2. REASONS GIVEN BY INACTIVE NURSE RESPONDENTS FOR TAKING A REFRESHER COURSE 40 LIST OF TABLES 1. NUMBER AND PERCENTAGE DISTRIBUTION OF RESPONDENTS AND NON-RESPONDENTS IN THE STUDY POPULATION 2. NUMBER AND PERCENTAGE DISTRIBUTION OF RESPONDENTS ACCORDING TO EMPLOYMENT STATUS IN NURSING 3. NUMBER AND PERCENTAGE OF INACTIVE NURSES ACCORDING TO MARITAL STATUS, AGE, AGE OF YOUNGEST CHILD AND INCOME 4. NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS ACCORDING TO REGISTRATION STATUS 5. NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS ACCORDING TO HIGHEST EDUCATION IN NURSING AND DATE COMPLETED , 6. NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS ACCORDING TO EMPLOYMENT EXPERIENCE AS REGISTERED NURSE 7. NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS ACCORDING TO EMPLOYMENT STATUS (OTHER THAN AS REGISTERED NURSE) . 8. NUMBER AND PERCENTAGE OF INACTIVE NURSE RESPONDENTS ACCORDING TO FUTURE EMPLOYMENT PLANS IN NURSING 9. NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS SHOWING PERCEIVED ADVANTAGES OF WORKING AS A REGISTERED NURSE 10. NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS SHOWING PERCEIVED DISADVANTAGES TO WORKING AS A REGISTERED NURSE 11. NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS (PLANNING TO RESUME EMPLOYMENT AS REGISTERED NURSE) SHOWING EMPLOYMENT PREFERENCE, REGIONAL HOSPITAL DISTRICT AND PERCENTAGE DISTRIBUTION OF DIFFICULT-TO-FILL POSITIONS 12. NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS (PLANNING TO RESUME EMPLOYMENT AS REGISTERED NURSE) ACCORDING TO CLINICAL PREFERENCE v i i 27 30 32 34 35 37 38 42 43 44 47 49 v i i i 13. NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSES (PLANNING TO RESUME EMPLOYMENT AS REGISTERED NURSE) ACCORDING TO RESTRICTIONS ON EMPLOYMENT ' 51 14. NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS (NOT PLANNING TO RESUME EMPLOYMENT AS REGISTERED NURSE) ACCORDING TO FUTURE PLANS IN NURSING 52 ix ACKNOWLEDGEMENTS There are a number of people without whose help this study would never have been possible. I wish to thank my thesis committee for their continuous encouragement, support and patience: Sheila Stanton, chairman, for her knowledge and expertise so willingly shared, her editorial comments and friendship; and Annette Stark for her interest, guidance and c r i t i c a l appraisal during each phase of the study. I am indebted to the British Columbia Institute of Technology, Department of Health Continuing Education and in particular to Roy Morris, Bonnie Lanz and Moira Barnetson, who allowed me access to the refresher course mailing l i s t and whose help was invaluable during the data collection phase. Appreciation i s also extended to Kerry Kerluke and Sharon Jansen for their willing and expert assistance with computer coding and computer programming. Special thanks go to the nurses who volunteered to participate: their cooperation in completing the questionnaire was essential to the successful outcome of the study. I am also indebted to Primrose Gontier for typing a l l the materials for the study, including the manuscript. And f i n a l l y , to Bruce, Lachlan and Angus, know you were needed. CHAPTER I INTRODUCTION Context of the.Problem B r i t i s h Columbia i s one of many provinces in Canada affected by a shortage of nurses (Canadian Nurse July-August 1980, pp. 6-10). Evidence of t h i s comes from a number of sources. The Registered Nurses' Association of B r i t i s h Columbia compiles monthly s t a t i s t i c s on a v a i l a b l e nursing p o s i -tions i n B r i t i s h Columbia. In June 1980, 489 u n f i l l e d p o s i t i o n s were * reported. The Health Manpower Research Unit reports, monthly, on p o s i t i o n s in the B r i t i s h Columbia health care industry that have been vacant for t h i r t y days without a suitable replacement being r e c r u i t e d . (Division of Health Services Research and Development 1980). Figures for June 1980 revealed there were 193 p o s i t i o n s for nurses with general preparation l i s t e d as " d i f f i c u l t - t o - f i l l " and 99 f o r nurses with s p e c i a l (post-basic) preparation. A series of a r t i c l e s i n the Vancouver Sun and The Province newspapers p u b l i c i z e d the shortage of nurses i n Vancouver and throughout the province (Bateson 1980; F r a l i c 1980). Several h o s p i t a l s were reported to have 20 or more u n f i l l e d r e g i s t e r e d nurse p o s i t i o n s ; some patient units were also reported to have been closed, at l e a s t i n part because of a shortage of nurses. Hospital administrators were quoted as saying that even extensive r e c r u i t i n g e f f o r t s across Canada had not s u f f i c e d to meet t h e i r present * Marion Greenwood, Career Counsellor, Registered Nurses' Association of B r i t i s h Columbia, 1980: personal communication. 1 2 requirements f o r nurses. The shortage of nurses i n B r i t i s h Columbia i s representative of a nation a l shortage which has existed i n Canada since the beginning of World War I I . I n i t i a l l y i t was believed that the shortage of nurses was temporary, but t h i s has not been the case. The p r o f e s s i o n a l nurse shortage has per-s i s t e d and i n t e n s i f i e d i n the succeeding 40 years. The Canadian Nurses' Association in i t s submission to the Royal Commission on Health Services (1962, p. 62) stated: Despite a favourable r a t i o of nurses to population i n comparison with other countries, there i s a shortage of nursing services i n Canada both i n quantity and q u a l i t y . The present supply of nurses i s not meeting the demand i n c e r t a i n areas of the country, nor i n some f i e l d s of nursing. The Royal Commission on Health Services (1962), concerned with the pr o v i s i o n of high q u a l i t y health care for a l l Canadians, stated i n i t s f i n a l report that the q u a l i t y of health services depended p r i m a r i l y on the supply, a v a i l a b i l i t y , knowledge, s k i l l and dedication of p r o f e s s i o n a l l y q u a l i f i e d personnel, and i d e n t i f i e d an inadequacy of health personnel, p a r t i c u l a r l y nurses, as one of the major problems confronting the Canadian health care system. In a study of nursing education i n Canada, Mussallem (1965, p . l ) observed that, "So serious i s the need for more nurses (in 1965) that many believe i t can jeopardize the e n t i r e structure of medical care." In the early 1970's i t was thoughtthat the problem of nurse shortages i n Canada had been overcome and, i n fact, a surplus of nurses was predicted on the basis of figures that indicated a growing r a t i o of nurses to popula-t i o n (DuGas 1971). By 1973, however, these projections proved to be inaccurate, at l e a s t f o r B r i t i s h Columbia where severe shortages were reported. It was concluded at that time that i n spite of a favourable nurse 3 to population ratio, the overall supply of nurses in British Columbia was not sufficient to meet current requirements (Registered Nurses' Association of British Columbia 1973). In a study for the Ministry of Science, Educa-tion and Technology, Kermacks (1979) concluded that cycles of very short supply and then adequate supply seem to characterize the nursing work force, and that British Columbia was moving into a short supply period, despite a continuing rise in the proportion of nurses to population. Several factors have contributed to the persistent shortage of regis-tered nurses in Canada. The introduction of medicare in the 1960's resulted in increased ut i l i z a t i o n of health care f a c i l i t i e s . This increased ut i l i z a t i o n required more nurses to provide the care needed by patients. In addition, advances in medical technology used in the treatment of illness have increased the need for highly skilled nursing care and require more registered nurses to provide that care. Another factor that has contributed to the shortage has been voluntary withdrawal of registered nurses from the work force. According to Statistics Canada (1978, p. 19), only 76.5 percent of nurses registered in Canada in 1976 were employed in nursing. The Registered Nurses' Association of Br i t i s h Columbia l i s t s 21,625 nurses registered in 1980; of this total, 5167, or 23.9 percent were not employed in nursing (Division of Health Services Research and Develop-ment 1980, p.5-5). This figure may be conservative as an indicator of unused manpower potential as i t does not include nurses who are not employed in nursing and who have not maintained nurse registration in British Columbia. A major concern of the investigator has been the supply of registered nurses in Br i t i s h Columbia. There are several potential sources for increased supply, including increased output from schools of nursing, 4 increased immigration of nurses from other provinces and other countries and recruitment of i n a c t i v e nurses back into the work force. The output of nurses from schools of nursing has increased s t e a d i l y since World War I I , but has not been adequate to meet the increased requirements for nursing services (Registered Nurses' Association of B r i t i s h Columbia 1973). Ten years ago, 46 percent of new nurse r e g i s t r a n t s i n B r i t i s h Columbia were educated i n B r i t i s h Columbia; i n 1980, graduates from nursing education programs i n B r i t i s h Columbia comprised only 32 * percent of new r e g i s t r a n t s . Increasing the numbers of students e n r o l l e d i n basic nursing education programs would appear to be an e f f e c t i v e method of expanding the supply of nurses i n B r i t i s h Columbia, but there i s some question of the a c c e p t a b i l i t y of proposals that would require increased government expenditure at a time when the costs of education are soaring and government i s committed to p o l i c i e s of r e s t r a i n t . In addition, the a v a i l a b i l i t y of appropriate c l i n i c a l f a c i l i t i e s and prepared teachers i s by no means assured. H i s t o r i c a l l y , the main source of nurse manpower i n B r i t i s h Columbia has been through immigration of r e g i s t e r a b l e nurses from other provinces and other countries (Registered Nurses' Association of B r i t i s h Columbia 1973). With nursing shortages now being reported world wide, (Bergman 1975), i n s u f f i c i e n t numbers of nurses are a v a i l a b l e from these sources to meet present requirements i n B r i t i s h Columbia. Another p o s s i b i l i t y for increasing the supply of r e g i s t e r e d nurses i s to r e c r u i t i n a c t i v e nurses back i n t o the nursing work fo r c e . Nurses who are v o l u n t a r i l y i n a c t i v e c o nstitute a source of supply that has been larg e l y ignored, although i t i s known that nurses move i n and out of the * Marilyn Carmack, Executive D i r e c t o r , Registered Nurses Association of B r i t i s h Columbia, 1980: personal communication. 5 work force depending upon family r e s p o n s i b i l i t i e s (Registered Nurses' Association of B r i t i s h Columbia 1973). I t has been observed that, "Only i n times of r e a l c r i s i s has there been genuine i n t e r e s t i n a c t i v a t i n g the i n a c t i v e nurse." (Cooper 1967, p.62). There has never been any r a t i o n a l planning for the orderly re-entry of i n a c t i v e nurses into the nursing work force, yet these nurses represent a s i g n i f i c a n t portion of e x i s t i n g educationally prepared nurses. A nurse who has been in a c t i v e f o r some time may not want to resume active p r a c t i c e without preparation. Changes i n medicine and i n nursing have made many of these nurses p r o f e s s i o n a l l y obsolete. It i s generally accepted that preparation for p r o f e s s i o n a l re-entry i s best accomplished through an e f f e c t i v e refresher course plus an adequate o r i e n t a t i o n to the s p e c i f i c p o s i t i o n a nurse accepts. Very l i t t l e i s known about i n a c t i v e nurses i n B r i t i s h Columbia who seek updating - t h e i r c h a r a c t e r i s t i c s , t h e i r employment plans, and the extent to which they represent a v i a b l e source of nursing manpower. In e arly 1980, approximately 450 graduate nurses had placed t h e i r names on the mailing l i s t for the Refresher Course for Graduate Nurses at the B r i t i s h Columbia I n s t i t u t e of Technology, a course which presently accommodates 60 students a year. An examination of the c h a r a c t e r i s t i c s of these nurses, together with information about t h e i r future employment plans may provide information that w i l l help to answer the question: do ina c t i v e nurses represent a p o t e n t i a l source of nursing manpower for the province? 6 Statement of the Purpose ^ This study has two purposes ; f i r s t , to describe selected character-i s t i c s of nurses who have expressed interest in a nursing refresher course and,second, to determine the extent to which these nurses are a potential source of nurse manpower supply. Objectives of the Study Through administration of a mailed questionnaire to a l l graduate nurses on the mailing l i s t for a refresher course for graduate nurses, to: 1. Compile a profile of these nurses that describes selected personal and work-related characteristics, including demographic, educational and work experience information. 2. Describe their reasons for taking a refresher course. 3. Describe their future plans for employment as registered nurses, including restrictions on employability and preferences of position as well as location. 4. Describe the differences, i f any, between those nurses who plan to return to work in nursing and those who plan to remain inactive. Definition of Terms Inactive Nurse. A graduate nurse who is not employed in nursing. Graduate Nurse. An individual who has satisfactorily completed an educational program in nursing. Registered Nurse. A graduate nurse who is registered by the Registered Nurses' Association of British Columbia. 7 Refresher Course for Graduate Nurses. A course designed to prepare an inactive nurse for active practice (Registered Nurses' Association of British Columbia 1980). / Characteristics. Distinguishing features, such as marital status, age, age of youngest child, nursing and other education, and work experience. Employment Plans. A description of intent to seek or not to seek employ-ment as a registered nurse, including projected date of employment, position preferred and location, and limitations on employability. Limitations The study was subject to the following limitations: Limitations associated with the methodology. As with any questionnaire with no follow-up procedure, the researcher could not verify whether or not responses corresponded to the way in which respondents actually behave. The survey approach used did not provide for e l i c i t i n g information from the non-respondents. Furthermore, i t cannot be assumed that respondents were representative of the non-respondents. Limitations associated with the sample. Generalizations of any of the conclusions can only be made to a population of nurses similar to the one used in the study. Therefore, factors found to be predictors of an intent to return to work in nursing can be generalized only to nurses who indicate interest in a refresher course and who have similar demographic characteristics. 8 Organization of the Study Report This study report is organized into five chapters. Chapter I has outlined the purpose of the proposed study and presented an overview of the larger problem of nurse shortages. Chapter II presents a review of l i t -erature which considers the characteristics of inactive nurses, employ-ment patterns of women, factors thought to influence a nurse's decision to be employed in nursing and, f i n a l l y , refresher courses for graduate nurses. Chapter III describes the research methodology used in the study and includes development of the questionnaire, sample selection and procedures for data collection and data analysis. The description of the sample, the results of data analysis and discussion of the findings appear in Chapter IV. Summary and conclusions are presented in Chapter V, together with implications of the findings for nursing education and for nursing administration. CHAPTER II REVIEW OF RELATED LITERATURE Introduction The toal nurse manpower supply for any given constituency can be viewed as being composed of three groups: active supply - those register-ed nurses who are employed as such either f u l l or part time; prospective supply - those individuals undergoing education which w i l l prepare them for employment as registered nurses; and potential supply - graduate nurses who are not employed in nursing. The persistent shortage of nurses in British Columbia has drawn attention to the potential contri-bution of the third group, graduate nurses who are not employed as registered nurses, that i s , inactive nurses. Some of these nurses may want to resume active status but require a refresher course before doing so. This study focused on inactive nurses who had expressed an interest in a refresher course and sought to describe their characteristics, their future employment plans in nursing and to determine whether or not inactive nurses who seek updating represent a potential source of nursing manpower for British Columbia. Studies have not, unt i l recently, been concerned with the potential contribution to the work force of the inactive nurse. Two study reports completed since 1970 acknowledge, however, that inactive nurses represent a potential source of supply and make recommendations for further study of this group (Murray 1970; Registered Nurses' Association of British Columbia 9 1973). Murray (p. 94), for example, observes that despite evidence that there were more than 13,000 registered nurses in Ontario who were not working in nursing, there had not been any studies designed to find out what i t would take to attract them back to work or how many of them would be able to function adequately i f they did return. This investi-gator i s not aware of any such published reports in Canada. More attention has been focused on voluntarily inactive nurses in the literature emanating from the United States. There is evidence of considerable concern over the fact that while the a t t r i t i o n rate from the nursing work force has been estimated by Bayer (1967) to have been as high as 55 percent in the early 1960's, few efforts have been directed towards reducing at t r i t i o n and/or attracting inactive nurses back into the work force. The reasons nurses withdraw from the work force are widely held to be both economic and social. Low salaries and family responsibilities are most often cited by nurses as reasons for inactivity (Anderson and Viko 1967; Marshall and Bruhn 1967; Platou and Peder son 1967; Reese et a l . 1962). The results of studies by Corwin (1961), Krueger (1971) and McCloskey (1974) suggest that dissatisfaction with the nurse's work i t s e l f i s a third variable that contributes to voluntary inactivity. The focus of the literature review which follows i s on studies that have investigated voluntary inactivity of graduate nurses. A search of nursing and related literature was conducted considering the characteristics of inactive nurses and those inactive nurses who have sought updating, the employment of women, and f i n a l l y , the factors which influence a nurse's decision to be employed in nursing. Studies related to refresher courses for graduate nurses were also reviewed. 11 Characteristics of Inactive Nurses The characteristics of inactive nurses have been described by Anderson and Viko (1967), Barker and Staton (1965), Buchan (1966), Marshall and Bruhn (1967), Platou and Pederson (1967) and Reese, Siegal and Testoff (1964). . Reese, Siegal and Testoff (1964) compiled studies conducted in 12 states to determine the characteristics of inactive nurses and what plans they had for returning to active practice. The data were obtained through questionnaires mailed to a l l inactive nurses currently register-ed and resident in each state. A profile of an inactive nurse emerged. She was married, 39 years of age or younger and had one to three children, the youngest of whom was under five years of age. Forty-four percent of the 10,141 nurses who responded stated they planned to return to active practice within the next 10 years. Sixty-five percent of those planning to return to work indicated they would like a refresher course before they did so. Family responsibilities were given as the major reason for voluntary inactivity by the 49 percent who planned to return to active practice and by the 31 percent of those who did not. Those nurses who indicated an intent to return to work stated that their plans to do so were predi-cated to a major extent on the av a i l a b i l i t y of suitable child care arrangements. Nurses who planned to remain inactive cited husband's preference as the most important reason for not seeking employment. The Kentucky Mental Health Manpower Commission Study sought new methods of easing the shortage of nurses in mental institutions in Kentucky (Barker and Staton 1965)• As in the previously cited work, similar population and research methods were used. Similar findings were reported. Buchan (1966) r e p l i c a t e d the Kentucky study i n Canada with a sample of 440 i n a c t i v e nurses i n Alberta. Her unpublished f i n d i n g s , based on an 85 percent response rate, were comparable to those of the two previous studies. An i n a c t i v e nurse in Alberta was most l i k e l y married and under 40 years of age with one to three c h i l d r e n at home, the youngest of whom was of pre-school age. Anderson and Viko (1967) reported on a two phase study project designed to augment the supply of working nurses in one upstate New York community. The f i r s t involved surveying i n a c t i v e nurses i n the community to f i n d out whether they wanted to return to work i n nursing and the second brought nurses who wanted to return to work into contact with t h e i r prospective employers. Data were c o l l e c t e d by means of a questionnaire mailed to 5200 ina c t i v e nurses. Of the 3100 who r e p l i e d , 398 (12.8 per-cent) expressed an i n t e r e s t i n returning to work in nursing. Of that number, 78 percent indicated they would prefer part-time employment. Two hundred and s i x (52 percent) of the nurses intere s t e d i n returning to work indicated a need for a refresher course. Platou and Pederson (1967) conducted a survey of r e g i s t e r e d but unemployed nurses i n one Minnesota county to determine what actions might a t t r a c t these nurses to the h o s p i t a l s e t t i n g . Of the 1026 questionnaires mailed, 708 (69 percent) were completed and returned. The c h a r a c t e r i s t i c s of the respondents (age, marital status and number of children) were si m i l a r to those of respondents i n the previous studies. L i t t l e d i f f e r -ence was discovered i n the c h a r a c t e r i s t i c s of nurses who wanted to work and those who did not. Three hundred and eighteen of the respondents said they would d e f i n i t e l y be interested i n employment i f c e r t a i n conditions were met. The majority stated they would prefer part-time employment. 13 Flexible hours and scheduling and competent child care constituted the major conditions to be met by returning registered nurses in the study. There was evidence that respondents who stated they did not want to return to work were influenced by a negative attitude towards employ-ment on the part of their husbands. Personal fulfillment was reported as the prime motivating factor for the greatest number of respondents. It was concluded that the recruit-ing potential for inactive nurses in this study was limited to part-time positions. Marshall and Bruhn (1967) examined the characteristics that distinguish inactive nurses who enrolled in a refresher course and returned to active nursing practice from other inactive nurses. Questionnaires were mailed to a study group of 92 registered nurses who had completed a refresher course and were known to have returned to active practice; they were also mailed to a comparison group of 265 systematically random sampled nurses who were registered but not employed in nursing. The response rate for the study group and the comparison group were 72 and 49 percent respectively. The results of this study showed no difference between groups with respect to type of basic nursing education program, marital status or number of children. Age, number of years since graduation from nursing school and number of years inactive distinguish the two groups. Nurses in the study group had a median age of 47 years, compared with 39 years in the comparison group. Nurses in the study group had completed their basic nursing education an average of 26 years prior to the study as compared to 12 for the comparison group. Similarly, nurses in the study group had been inactive for seven years in contrast to one year for those 14 in the comparison group. The major reasons given by the nurses in Marshall and Bruhn's (1967) study group for being currently employed in nursing were financial need, a desire to keep informed and interest in nursing. For those who were inactive, the main reasons given for their inactivity were family responsibilities, disillusionment with the profession, inadequate salaries and unsuitable hours. Findings suggested that a number of inactive nurses returned to active practice when there was financial need and/or family responsibilities had lessened. The findings of this study are at variance with those reported earlier by Reese, Siegal and Testoff (1964). In the latter study, i t was concluded that as the age of the inactive nurse increased, the proportion who intended to return to active practice decreased; the longer a nurse was inactive, the less l i k e l y she was to return to active status. Seventy percent of those who had been inactive for less than a year indicated an intention to return whereas less than 25 percent who had been inactive for 10 years planned to return to active practice. On the other . i hand, Marshall and Bruhn (1967) found that the nurses who were actually returning to work in nursing after a period of inactivity were older and had been inactive longer than those who chose not to return to work. A longitudinal study initiated in 1962 (Knopf 1975; Knopf 1979) is the only known attempt to follow a cohort of nurses from the time they entered a nursing education program through their working lives. Preliminary results confirmed that work status is closely associated with marital status and children and imply that a source of nursing manpower may be the older married woman whose children are of school age or beyond. 15 Employment Patterns of Women Interest i n a c t i v a t i n g the inactive nurse appears to be not only a function of the presence or absence of a balance between active nursing supply and nurse requirements, but also of changing s o c i e t a l a t t i t u d e s towards women and work. During the period since World' War I I , the number of nurses remaining v o l u n t a r i l y i n a c t i v e i n the United States has dropped from 49 percent i n 1951 to 30 percent i n 1972 (Levine 1978). Although research i n t h i s area i s lacking, i t has been suggested that more nurses are returning to active p r a c t i c e today, i n part because of pe r s i s t e n t shortages, but also because s o c i e t a l trends have made i t much more accept-able for women to combine marriage and a career. Since nursing i s predominantly a female occupation - over 98 percent of nurses i n Canada are women ( S t a t i s t i c s Canada 1978, p. 37) - changes i n the patterns of women's l i v e s over the past 30 years have had a d i r e c t e f f e c t upon nurses and nursing. The labour force p a r t i c i p a t i o n rate for married women i n Canada has increased markedly over the past 20 years. In 1977, 44.1 percent of a l l married women i n the population were i n the labour force, compared with 26.8 percent i n 1966 and 19.2 percent i n 1960 (Women's Bureau 1978; Women's Bureau 1975). There i s evidence of an emerging pattern wherein a woman leaves the labour force upon the b i r t h of her f i r s t c h i l d and re-enters l a t e r when family r e s p o n s i b i l i t i e s are lessened. The highest labour force p a r t i c i p a t i o n f o r married women occurs i n the 20 to 24 year age group; the rate drops off i n the two subsequent age i n t e r v a l s , then r i s e s again a f t e r age 35 (Women's Bureau 1978). Employment patterns of nurses do not appear to d i f f e r greatly from employment patterns of women i n the general population, at le a s t up to 16 the age of 35. When Altman compared the labour force participation rates of nurses with those of female high school graduates, female college graduates and total women by age groups, comparisons revealed the same b i -modal pattern for a l l groups which was high participation following graduation from school, a f a l l i n g off in the rate during the child bearing ages and a second rise after age 35. The findings of this study also revealed that although the employment patterns for nurses were similar to those of other groups studied, there was an important difference with respect to the actual numbers of nurses moving in and out of the work force. Nursing neither lost as many active participants during their late twenties and early thirties nor attracted as great a proportion back into the labour market after age 35 (Altman 1971, p.103). The reasons for this difference were not readily apparent, but Altman points out that a lower marriage rate for nurses in the United States could account for fewer nurses leaving the work force, and that occupational obsolescence could impede the return of those who do leave. Bayer (1967) estimated the reserve work force for five predominantly female occupations and found that compared to other groups of professional women, nurses are generally less active in their profession. Estimates varied from a high of 55 percent for nurses to 48 percent for social workers, 37 percent for librarians and 38 percent for elementary teachers. While he suggests the conflict between work and family tQ be particularly acute for nurses, actually there are a number of factors that apparently influence a nurse's decision to be employed in nursing. . 17 Factors A f f e c t i n g Employment of Nurses Studies of labour force p a r t i c i p a t i o n rates of married female nurses have shown that the primary determinants of employment are wage rates, husband's income and the presence of small c h i l d r e n . Benham (1971), for example, estimated t h i s r e l a t i o n s h i p and confirmed that the nurse's salary had a p o s i t i v e e f f e c t on the p a r t i c i p a t i o n rate, while the e f f e c t s of husband's income and the presence of pre-school c h i l d r e n were both negative. Bognano, Hixon and J e f f e r s (1974) estimated the response of married nurses to a change i n wage rates and husband's earnings and concluded that the wife works to supplement family income. In other words, as the husband's income r i s e s , the married nurses' propensity to work f a l l s . Link and S e t t l e (1980) investigated the e f f e c t of higher wages and other employment inducements on the supply of nursing services and found that higher wages would have the paradoxical e f f e c t of reducing the number of hours worked by married nurses. Cleland, et a l . (1970) investigated factors i n f l u e n c i n g 479 married nurses to r e a c t i v a t e t h e i r careers and found that f i n a n c i a l need and the absence of young c h i l d r e n were the best predictors of which women would choose to be a c t i v e l y employed. In addition, 41 percent of the respond-ents viewed time c o n f l i c t s between employment and home as the primary negative consequences of working. Inducements offered by nursing were not s u f f i c i e n t (measured i n terms of the i n a c t i v e nurse's values and the terms of a l t e r n a t i v e s open to her) to motivate her to make the c o n t r i -butions demanded i f she i s to reactivate her career (Cleland et a l . 1970, p. 451). Cleland suggests that the employment of married nurses can be character-ized by the p r i n c i p l e of immediate g r a t i f i c a t i o n , namely: rapid turnover and change of work status when family needs and family problems a r i s e ; 18 acceptance of dead-end jobs which are compatible with family needs and demands; and work goals which focus upon maintenance of existing s k i l l s rather than advancement or growth. Cleland, et a l . (1976) also investigated the nature of differences between married nurses who work only during periods of financial exigencies versus those who actively seek long-term professional careers. When the age of youngest child and financial need were held constant, the factors of career desirability, professional behaviour and economic value of work had the greatest correlation with employment activity. Studies by Altman (1971) and Hover (1976) suggest that the a t t r i t i o n rate from nursing is higher for nurses who have a baccalaureate degree in nursing. Hover (1976) found that nurses with baccalaureate degrees were more likely to seek promotions outside the hospital system, most often in education or research. Altman (1971) determined that the at t r i t i o n rate from nursing was highest for nurses with baccalaureate degrees and posits that career expectations are not met in nursing and consequently nurses with baccalaureate degrees and thus more f l e x i b i l i t y with regard to employment w i l l be more likely to seek employment outside nursing. Knopf (1975; 1979) has reported the i n i t i a l findings of a longitudinal study of nurse career patterns. When the work status of nurses with a basic diploma was compared with that of nurses with a baccalaureate degree five years after graduation, 30 percent of diploma nurses and 3A percent of baccalaureate nurses were not working in nursing. The number of nurses with a baccalaureate degree who were employed in non-nursing positions increased from one percent five years after graduation to six percent 10 years after graduation. Previous research has made i t clear that labour force participation 19 of nurses cannot be understood except i n the context of marital status and age of c h i l d r e n . Cleland (1970, p.450) suggests that: For the married female nurse, whose marriage i s v i a b l e , decisions p e r t a i n i n g to employment are based upon her perception of what i s best for the family. P o s i t i v e f i n a n c i a l consequences of work and opportunity to achieve career goals must be perceived as greater than the negative consequences i f the married woman i s to become and remain employed i n nursing. Nearly every study dealing with i n a c t i v e nurses points out the importance of family r e s p o n s i b i l i t i e s as a deterrent to returning to work i n nursing. The most common requests of nurses surveyed are for more f l e x i b i l i t y of hours and for c h i l d care se r v i c e s . Also of great import-ance to in a c t i v e nurses i s the a v a i l a b i l i t y of refresher courses. Refresher Courses f o r Graduate Nurses Several authors have investigated the effectiveness of refresher programs i n f a c i l i t a t i n g a return to a c t i v e status. Reese, et a l . (1962) commented on the employment status of 353 nurses who completed a refresher course. About 77 percent of the nurses were employed since taking the course. If i t i s assumed that those nurses attending a refresher course have some p r e d i s p o s i t i o n f or a return to active status, then t h i s r e s u l t i s not s u r p r i s i n g . Mayberry (1967) found that 65 percent of 680 nurses who completed a refresher program returned to work i n nursing. Some of the reasons given by nurses for continued or resumed i n a c t i v i t y included being unable to negotiate suitable hours of work or to make acceptable c h i l d care arrangements. Anderson (1968) reports the r e s u l t s of a study of 108 i n a c t i v e nurses who had taken a refresher course and confirms that the number and 20 age distribution of children in the family had the most influence on the number of hours and the time of day that the nurse was willing to work. Summary A review of literature concerned with the problem of voluntary inactivity among graduate nurses suggests that attempting to increase the unbroken tenure of nurses is probably f u t i l e since variables such as marriage and children affect tenure so strongly. It seems clear that many nurses w i l l have an interrupted career in nursing. What is not clear is whether this interruption is planned or simply happens as an adjunct to the nurses' lives as wives and mothers. Cooper (1967) suggests i t is the latter. The nurse who l e f t practice 15 or 20 years ago did not plan to return to nursing. She is now returning, often from economic necessity, but also as a result of lessening family responsi-b i l i t i e s and/or a wider acceptance of the working woman/mother, from a desire for personal fulfillment and from an awareness of the need for her services. Since she did not plan to return to practice, she made no effort to keep professionally current. As a consequence many returning nurses require refresher courses before they can resume active status. The decision of a nurse to work or not to work in nursing is thought to be influenced by two sets of variables; those related to the individual (personal variables) and those related to the work setting (work-related variables). Work-related variables include hours of work, available child care f a c i l i t i e s , salary and job satisfaction. An inactive nurse is likely to be married and under 40 years of age with pre-school aged children. Flexible hours and suitable child care 21 arrangements are the major conditions that have to be met before a nurse resumes ac t i v e status. Family r e s p o n s i b i l i t i e s , low s a l a r i e s and p r o f e s s i o n a l disillusionment are the main reasons why inactive nurses remain i n a c t i v e . F i n a n c i a l need and a desire for personal f u l f i l l m e n t provide the motivation for i n a c t i v e nurses to resume employment in nursing. None of the studies reviewed were concerned s p e c i f i c a l l y with des c r i b -ing the c h a r a c t e r i s t i c s of i n a c t i v e nurses who were ready to resume active status but required a refresher course before doing so. The extent to which refresher course candidates are s i m i l a r to or d i f f e r e n t from other i n a c t i v e nurses has not been documented. The studies reviewed provide support for the proposition that some d i n a c t i v e nurses plan to return to employment i n nursing i n the future and require a refresher course before doing so. The numbers and the c h a r a c t e r i s t i c s of inactive nurses who a c t u a l l y follow through with t h e i r plans to return to work i n nursing cannot be stated with confidence. In a r a p i d l y changing society, i t i s of i n t e r e s t that most of the studies p e r t a i n i n g to i n a c t i v e nurses were c a r r i e d out more than 10 years ago. As a consequence many of the findings may be outdated and not d i r e c t l y applicable to the present s i t u a t i o n . E a r l i e r studies, however, di d provide important background information and gave d i r e c t i o n for the present study. CHAPTER III METHODOLOGY Introduction This study was exploratory in nature. Survey methodology, u t i l i z i n g a mailed questionnaire, was selected as the research approach. The aim was to describe selected characteristics of inactive nurses who had expressed interest in a refresher course and to determine whether an expressed interest in a refresher course was a predictor of intent to return to work in nursing. Survey methodology, defined by Polit and Hungler (1978, p.206) as, "...that branch of research that examines the characteristics, behaviours, attitudes and intentions of a group of people by asking individuals belonging to that group (typically only a subset) to answer a series of questions," was considered most appropriate to achieve the stated research purpose. The literature reviewed indicated that an inactive nurse's decision to work or not work in nursing was likely a function of two sets of factors: those related to the individual, such as marriage .and children, and those associated with the work setting, such as hours of work and child-care f a c i l i t i e s . A structured questionnaire was developed by the investigator to collect data on selected personal and work-related variables and was mailed to a convenience sample of inactive nurses who had expressed interest in a refresher course. 22 23 Selection of the Sample Convenience sampling was used in this study. It is known that in today's technological society, re-entry into a profession such as nursing requires updating of knowledge and s k i l l , typically through a refresher course. For this reason i t was assumed that nurses who were interested in a nursing refresher course were not currently working as registered nurses and thus constituted a sub-sample of inactive nurses. Permission was obtained (see Appendix A) from a post-secondary educational institution that offered refresher courses on a regular basis to contact nurses on their refresher course mailing l i s t for this thesis project. A l l nurses whose names appeared on the mailing l i s t on February 1, 1980 and who had not yet been accepted for an upcoming course became the study sample. Development of the Instrument The instrument used for this study was a structured questionnaire developed by the investigator. Questions about personal and work-related variables which were thought to be related to a nurse's decision to be employed in nursing were drawn from the literature and incorporated into a 12 page questionnaire (see Appendix B). Questions were designed to collect four types of data: demographic, education, work experience and employment. Demographic data. These data, to be used to group respondents for purposes of data analysis, included age, marital status, age of youngest child and annual family income. These factors were selected because i t has been suggested they influence a nurse's decision to be employed in nursing. Education data. Since nursing education has two distinct paths, 24 diploma and baccalaureate, i t was considered appropriate to request information about type of basic nursing education in order to group respondents on this variable when examining future employment plans. Other data in this section - post-basic nursing education and education in other than nursing - were solicited to allow additional groupings of respondents. Work experience data. Information about previous work experience was requested to permit groupings of respondents according to the number of years they had worked as registered nurses prior to becoming inactive and the number of years they had been inactive. Of interest as well was the work experience of respondents in health-related and non-health-related fie l d s . Employment data. The focus of this study was the determination of the future employment plans of refresher course candidates. Accordingly, questions were formulated to collect data on selected work-related variables: plans for future employment as a registered nurse, position desired, date available for employment, full-time or part-time and other restrictions on employment. Questions were also designed that el i c i t e d respondents' reasons for taking a refresher course and the advantages and disadvantages they perceived in working as a registered nurse. A summary of personal and work-related variables used in this study is presented in Figure 1. Pretesting The i n i t i a l draft of the questionnaire was c r i t i c a l l y discussed by a panel of nurse colleagues who were both knowledgeable about the construction of questionnaires and familiar with the substantive content. The panel included six nurses who were enrolled in the Master of Science in Nursing PERSONAL WORK RELATED 25 Marital Status Single Married Other Age Under 25 25 - 29 30 - 34 35 - 39 40 - 44 45 50 55 60 59 54 59 64 Age of Youngest Child Under 5 15-17 5 - 9 18 or over 10 - 14 Annual Family Income Less than $10,000 $10,000 - $19,000 $20,000 - $29,000 $30,000 or over Education Basic Nursing Education Diploma Degree Post-basic Nursing Education Other post-secondary education Registration Practicing Non-practicing Resigned Never Registered Employment Status Presently Employed as an R.N. Unemployed and not seeking employment as an R.N. Unemployed and seeking employment as an R.N. Unemployed and seeking employment as an R.N. but restricted Employed other than as an R.N., not seeking employment as an R.N. Employed other than as an R.N., prefer employment as an R.N. Employed other than as an R.N., prefer employment as an R.N., but restricted. Work experience Registered Nurse Health Related Other Volunteer Date last employed Full-time Part-time Advantages and Disadvantages to Number of years employed as a regis-working as a Registered Nurse tered nurse Full-time Part-time Cl i n i c a l area(s) Future employment plans as a registered nurse Part-time Full-time Geographic location C l i n i c a l area Other Plans Restrictions on Employability FIGURE 1 LIST OF VARIABLES 26 p r o g r a m at the University of B r i t i s h Columbia and four members of the School of Nursing f a c u l t y . Comments were sought concerning the appropriate-ness and adequacy of the content. In addition, the questionnaire was reviewed by a coder and a programmer/analyst to detect and advise on t e c h n i c a l d i f f i c u l t i e s . A revised version of the questionnaire was tested by 30 nurses who had been accepted f o r a refresher course and therefore would not be part of the main study. The purpose of the t e s t was to help assess the c l a r i t y , adequacy and freedom from bias of the questionnaire items. While a pre-test cannot guarantee a perfect instrument, i t can "... provide an opportu-n i t y f or detecting at least gross inadequacies or unforseen problems before going to the expense of a f u l l scale study." ( P o l i t and Hugler 1978, p.347). Results from the pretest were used to make several e d i t o r i a l - t y p e changes i n the questionnaire and one major r e v i s i o n . In the pretest, respondents were asked i n an open-ended question to l i s t three reasons for taking a refresher course. To f a c i l i t a t e s t a t i s t i c a l a n a lysis and to increase the r e l i a b i l i t y of the instrument, a f i x e d - a l t e r n a t i v e question was developed from the responses given on the pretest. A l i s t of 11 alternate responses was developed using a modified content analysis technique (Kerlinger 1973). The unit of analysis was "reason for taking a refresher course." E i g h t y - s i x responses from the pretest were sorted into 24 categories and then the number of units i n each category was counted. Only categories containing at l e a s t three units were retained. The r e s u l t i n g eleven categories were then v a l i d a t e d by two nursing colleagues and incorporated i n t o the revised questionnaire. 27 F i n a l Questionnaire The f i n a l questionnaire, modified on the basis of pret e s t i n g , consisted of 25 questions r e l a t e d to the study project and of the f i x e d response type. Response a l t e r n a t i v e s were varied, i n c l u d i n g dichotomous items, multiple choice items, funnel and rank order questions. A set of 14 questions (Items 19 through 32) requesting information about respondents' i n t e r e s t i n a part-time refresher course was included i n the questionnaire at the request of the sponsoring agency but was not considered part of the study project and w i l l not be reported on here. R e l i a b i l i t y and V a l i d i t y of the Instrument Actions c a r r i e d out to enhance the c l a r i t y of the research instrument included a c r i t i c a l review by a panel of experts and a pretest. In addition, since a l l of the items were of the fi x e d response type, the p o t e n t i a l f o r uniformity of stimulus and thus greater r e l i a b i l i t y was achieved (Kerlinger 1973). A panel of nurse experts was used to help e s t a b l i s h content v a l i d i t y . Administration of the Questionnaire On February 13, 1980, questionnaires were mailed to 413 graduate nurses whose names were on the Refresher Course mailing l i s t as of February 1, 1980. Accompanying the questionnaire was a covering l e t t e r s t a t i n g the nature of the study, g i v i n g general d i r e c t i o n s , o u t l i n i n g p a r t i c i p a n t r i g h t s and requesting the cooperation of the respondents (see Appendix C). A stamped, self-addressed envelope and postcard were included i n the questionnaire packet. Respondents were asked to indicate on the postcard whether or not they wished t h e i r name to continue on the refresher 28 course mailing l i s t and to sign and return i t separately from the question-n a i r e . The main purpose of the postcard was to permit the course administr-at i o n to update t h e i r mailing l i s t but i t was also used to f a c i l i t a t e a second mailing to only those respondents who had not returned the postcard. Response Rate A four week period was allowed f o r return of the questionnaires. During t h i s period, 140 completed questionnaires were returned and three questionnaires were returned as non-deliverable. The response rate was 34.1 percent. As respondents remained anonymous, a decision was made to attempt to improve the response rate by sending follow-up l e t t e r s (see Appendix D) to nurses who had not returned the postcard, assuming that those who had not returned the postcard had also not returned the questionnaire. A t o t a l of 199 v a l i d questionnaires out of a possible 410 was received by the deadline set for i n i t i a t i o n of data analysis (Table 1). The f i n a l response rate was 49 percent. A questionnaire was deemed v a l i d i f i t contained at least the information on present employment status i n nursing and future plans f o r employment. No attempt was made to assess the nature of the non-respondents nor the reasons f o r t h e i r non-response. TABLE 1 NUMBER AND PERCENTAGE DISTRIBUTION OF RESPONDENTS AND NON-RESPONDENTS IN THE STUDY POPULATION (N=410) „ i • Number Percent Study Population n u f f l D e i ;  _ , 199 48.6 Respondents L v y Non-Respondents 211 51.4 Total " 0 100.0 29 Of the 280 respondents who returned the postcard, 68 (24 percent) indicated they would l i k e to have t h e i r name removed from the course mailing l i s t . As the questionnaires were returned anonymously, i t was not possible to assume that those who requested that t h e i r names be removed from the mailing l i s t did not complete the questionnaire. Data Analysis The data were analyzed using the S t a t i s t i c a l Package f o r the S o c i a l Sciences (Nie, et a l . 1975). To determine i f there was a d i f f e r -ence between inactive nurses who planned to return to work i n nursing and those who did not, i n a c t i v e respondents were assigned to one of two sub-groups: nurses planning to return to work as registered nurses and nurses planning to remain i n a c t i v e . Frequencies were calculated for each group and a chi-square s t a t i s t i c applied to selected v a r i a b l e s : m a rital status, age, age of youngest c h i l d , annual family income, number of years since completion of basic nursing education and number of years inactive i n nursing. A l l s t a t i s t i c a l analyses were tested against an alpha c r i t e r i o n of p<.05 and are reported i n Chapter IV. CHAPTER IV FINDINGS AND DISCUSSION Introduction Data from 199 questionnaires were tabulated under three categor-i e s : respondents who were employed as registered nurses (N=46), respond-ents who were i n a c t i v e i n nursing but who planned to resume ac t i v e status as registered nurses upon completion of a refresher course (N=101) and respondents who were i n a c t i v e i n nursing and planned to remain i n a c t i v e a f t e r completing a refresher course (N=52). Table 2 shows the d i s t r i -bution of respondents according to employment status i n nursing. TABLE 2 NUMBER AND PERCENTAGE DISTRIBUTION OF RESPONDENTS ACCORDING TO EMPLOYMENT STATUS IN NURSING (N=199) EMPLOYMENT STATUS Number Percent Employed as Registered Nurse 46 23.1 Not Employed as Registered Nurse 153 76.9 Plan to resume employment as R.N. 101 66.0 Do not plan to resume employment 52 34.0 as R.N. Total 199 100.0 30 31 The r e s u l t s of data analysis are presented i n f i v e sections. Section A presents the demographic, education and work experience c h a r a c t e r i s t i c of the respondents. Section B describes the reasons given by respondents for taking a nursing refresher course. Section C describes the employment p o t e n t i a l of the sample of i n a c t i v e nurses and includes perceived advantages and disadvantages to working as a re g i s t e r e d nurse, future employment plans i n nursing and r e s t r i c t i o n s on employability. In Section D nurses who plan to return to work i n nursing are compared with those who plan to remain i n a c t i v e . The f i f t h section (E) contains a b r i e f d e s c r i p t i o n of the respondents i n the study who were already employed as r e g i s t e r e d nurses. Space was provided at the end of the questionnaire f o r respondents to write a d d i t i o n a l comments i f they desired. Sixty-one nurses took t h i s opportunity to express a wide range of concerns and opinions about nursing, about t h e i r own i n c l i n a t i o n and a b i l i t y to resume employment as a r e g i s t e r e d nurse and about the refresher course i t s e l f . These are summarized and presented, with examples, i n Appendix E. A. Demographic, Education and Work Experience C h a r a c t e r i s t i c s of Respondents The c h a r a c t e r i s t i c s of the sample of 153 i n a c t i v e nurses accord-ing to demographic, education and work experience v a r i a b l e s i s presented i n Tables 3 to 7. M a r i t a l status, age, age of youngest c h i l d and annual family income of respondents are presented i n Table 3. The sample was composed e n t i r e l y of women. A majority were married (83.7 percent) and over 40 years of age (54.2 percent). With respect to age of youngest c h i l d , 14.5 percent of the 138 respondents who 32 TABLE 3 NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSES ACCORDING TO MARITAL STATUS, AGE, AGE OF YOUNGEST CHILD AND INCOME (N=153) CHARACTERISTICS Number Percent Marital Status Single 9 5.9 Married 128 83.7 Other 16 , 10.4 Total 153 100.0 Age 25-29 years 4 2.6 30-34 years 22 14.4 35-39 years 44 28.8 40-44 years 38 24.8 45-49 years 25 16.3 50-54 years 12 7.8 55 years and over 8 5.3 Total 153 100.0 Age of Youngest Child Under 5 years 20 14.5 5-9 years 43 31.1 10-14 years 42 30.4 15-17 years 15 10.9 18 years and over 18 13.1 Total 138 100.0 Annual Family Income Less than $10,000 10 6.8 $10,000 - $19,000 28 18.9 $20,000 - $29,000 49 33.1 $30,000 and over 61 41.2 Total 148 100.0 33 completed t h i s section reported t h e i r youngest c h i l d to be of pre-school age (under f i v e years). The majority (72.4 percent) of the respondents had c h i l d r e n of school-age. The findings f o r the two v a r i a b l e s , age and age of youngest c h i l d , are inconsistent with those reported i n e a r l i e r studies of i n a c t i v e nurses (Barker and Staton 1965; Buchan 1967; Reese, Siegal and Testoff 1964) where a majority of the i n a c t i v e nurses who p a r t i c i p a t e d i n the studies were under the age of 40 and had pre-school age c h i l d r e n but are consistent with the findings of Marshall and Bruhn (1967) who suggested that the i n a c t i v e nurse who returns to a c t i v e p r a c t i c e a f t e r completing a refresher course i s older than the population of i n a c t i v e nurses and has reduced family r e s p o n s i b i l i t i e s . An annual family income of $20,000 or more was reported by 74.3 percent of the respondents and f o r 41.2 percent i t was more than $30,000. Ten (6.8 percent) of the respondents reported an annual family income of under $10,000. The number of r e l a t i v e l y high incomes reported may be r e f l e c t i v e of f a m i l i e s where there are two wage earners. Re g i s t r a t i o n status of respondents i s shown i n Table 4. One hundred and s i x (69.3 percent) of the respondents reported they were not registered as a nurse i n B r i t i s h Columbia. Of t h i s number, however, 51 (48.1 percent) reported they had resigned i n good standing which means that they can become registered again by paying the current r e g i s t r a t i o n fee. The t o t a l number of respondents, then, who were eit h e r registered or r e g i s t r a b l e i n B r i t i s h Columbia was 98 (64.1 percent). The composition of the sample of i n a c t i v e nurses according to highest education i n nursing and according to the date basic nursing education was completed i s reported i n Table 5. A diploma i n nursing was the highest educational q u a l i f i c a t i o n f o r 124 (81.0 percent) of the 34 TABLE 4 NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS ACCORDING TO REGISTRATION STATUS (N=153) REGISTRATION STATUS Number Percent Registered i n B r i t i s h Columbia Not Registered i n B r i t i s h Columbia Resigned i n good standing i n B.C. Never r e g i s t e r e d i n B.C. Total 47 106 30.7 69.3 51 55 48.1 51.9 153 100.0 TABLE 5 NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS ACCORDING TO HIGHEST EDUCATION IN NURSING AND DATE COMPLETED (N=153) EDUCATION IN NURSING Number Percent Highest Education in Nursing Basic Diploma 124 81.0 Post-Basic Diploma/Certificate 24 15.7 Baccalaureate Degree 5 3.3 Total 153 100.0 Date Basic Nursing Education Completed 1940 - 1944 1 0.6 1945 - 1949 9 5.9 1950 - 1954 19 12.4 1955 - 1959 32 20.9 1960 - 1964 39 25.5 1965 - 1969 37 24.2 1970 - 1974 6 3.9 1975 - 1979 3 2.0 No response 7 4.6 Total 153 100.0 Mean number of years since basic nursing education completed: 19.5 Range: 36 years 36 inactive nurses in this study. One hundred and thirty-seven (89.5 per-cent) reported that they had completed their basic nursing education prior to 1970; 61 (39.8 percent) had completed i t prior to 1960. The mean number of years since completion of basic nursing education was 19.5, with a range of 36 years. Compared with the findings of earlier studies, respondents in this study had completed their basic nursing education earlier than other inactive nurses. Table 6 shows the number of years of full-time employment as a registered nurse as reported by the sample of inactive nurses. A majority had been employed in a full-time capacity for three years or less (54.9 percent), and of this number, five respondents indicated they had never been employed full-time as a registered nurse. The mean number of years since last full-time employment as a registered nurse (for nurses who reported previous full-time employment as a registered nurse) was 12.16. Table 7 provides evidence that some nurses who are not employed as registered nurses have sought alternate employment. Fifty-one (33.3 percent) of the inactive nurses in this study were employed other than as a registered nurse at the time they completed the questionnaire. Thirty-two (17.6 percent) were employed in health-related occupations and 19 (12.5 percent) in other occupations. The reasons why nurses in the study sample were employed in other than nursing were not readily apparent, but for some i t may have been because they were unable to be employed in nursing without f i r s t updating their knowledge and s k i l l s . Twenty-eight (54.9 percent) of the respondents who were employed other than as a registered nurse indicated they would have preferred employ-ment as a registered nurse but were restricted because of a lack of opportunity to update themselves in nursing. 37 TABLE 6 NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS ACCORDING TO EMPLOYMENT EXPERIENCE AS REGISTERED NURSE (N=153) EMPLOYMENT AS R.N. Number Number of Years Employed Full-Time  as Registered Nurse None 5 3.3 Less than 1 year 16 10.6 1 - 3 years 63 41.1 4 - 7 years 43 28.1 8 - 1 1 years 17 11.1 12 - 15 years 3 1.9 More than 15 years 4 2.6 No Response 2 1.3 Total 153 100.0 Date Last Employed Full-time as Registered Nurse 1945 - 1949 2 1.3 1950 - 1954 5 3.4 1955 - 1959 18 12.2 1960 - 1964 32 21.7 1965 - 1969 40 27.0 1970 - 1974 27 18.2 1975 - 1979 14 9.5 No Response 10 6.7 Total 148 100.0 Mean number of years since last employed full-time as R.N.: 12.16 Range: 33 years 38 TABLE 7 NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS ACCORDING TO EMPLOYMENT STATUS (OTHER THAN AS R.N.). (N=153). EMPLOYMENT STATUS Number P Not Employed Employed in Health Related Occupation Employed in Non-Health Related Occupation Total 69.9 17.6 12.5 100.0 102 32 19 153 39 B. Reasons for Taking a Refresher Course The assumption that inactive nurses take a refresher course primarily to become employed in nursing i s not supported by the data obtained in this study. Respondents were asked to rank the f i r s t , second and third most important reasons for taking a refresher course. The reasons why respondents would take a refresher course are shown in Figure 2. Fifty-one (34.2 percent) of the respondents indicated that "a desire to update nursing knowledge and s k i l l s " would be the most important reason for taking a refresher course, 21 (14.1 percent) indicated i t would be to "obtain British Columbia registration" and 18 (12.1 percent) would take a refresher course primarily to "become employable in nursing." Only 12 (8.1 percent) of the respondents indicated that the most important reason for taking a refresher course would be to "become employed in nursing." The second most important reason the inactive nurses (17.7 percent) would take a refresher course would also be "to update nursing knowledge and s k i l l s " and the third "to become employable in nursing" (23 percent). The reasons why respondents apparently viewed the process of updating as being more important than the outcome, employment in nursing, are not clear. The possibility that respondents f e l t some obligation to rank the reason that most closely resembled the refresher course purpose above their actual reason for taking a refresher course is acknowledged. If the reason given as being most important was biased in favour of the stated refresher course purpose, then the second most important reason given may in fact be a more valid representation of the nurse's real reason for taking a refresher course. To test this, the responses of 51 respondents who selected "update" as their f i r s t reason for taking a 40 refresher course were analyzed to determine t h e i r stated second and t h i r d most important reasons. When the f i r s t reason was set aside, employment i n nursing s t i l l received a low p r i o r i t y . The second most important reason for taking a refresher course f o r t h i s group of respond-ents would be "to gain confidence as a nurse" (29.1 percent), and the t h i r d , "to become employable i n nursing" (26.5 percent). The reasons tend to confirm the assumption that some ina c t i v e nurses view themselves as having outdated knowledge and s k i l l s as a consequence of prolonged i n a c t i v i t y i n nursing. Most Important Reason (N=149) Update nursing knowledge and s k i l l s Obtain B r i t i s h Columbia R e g i s t r a t i o n Become employable i n nursing Become employed i n nursing Second Most Important Reason (N=141) Update nursing knowledge and s k i l l s Gain confidence as a nurse Personal s a t i s f a c t i o n Become employable i n nursing Third Most Important Reason (N=139) Become employable i n nursing Update nursing knowledge and s k i l l s Personal s a t i s f a c t i o n Provide f o r stable and secure future 34.2% 14.1% 12.1% 8.1* 17.7% 14.4% 13.5% 12.1% 23% 16.6% 13.7% 12.3% FIGURE 2 REASONS GIVEN BY INACTIVE NURSE RESPONDENTS FOR TAKING A REFRESHER COURSE (N=153) 41 C. Future Employment in Nursing In light of the acute nursing shortages extant i n British Columbia at the time this study was initiated, the future employment plans of inactive nurses in the study sample were of particular interest. The numbers of budgeted but unfilled positions on the one hand and the large numbers of nurses interested i n refresher courses on the other, had resulted in considerable pressure being exerted on educators to increase the numbers of seats in existing courses and to create new refresher courses i n different regions of the province (Registered Nurses' Association of British Columbia May, 1980). If significant numbers of inactive nurses in the study sample could be shown to be planning to resume active status in nursing upon completion of a refresher course, there would be some just i f i c a t i o n for acting to f a c i l i t a t e an inactive nurse's early admission to a refresher course and her subsequent return to practice. The post-refresher course employment plans of 153 inactive nurses are shown in Table 8. A majority (66 percent) of the respondents indicated they planned to resume active status in nursing. Most (57.4 percent) would prefer part-time employment. Additional data were sought in order to provide more specific information about the manpower potential of the inactive nurses sampled, including: the perceived advantages and disadvantages to working as a registered nurse; projected date of employment in nursing; location; c l i n i c a l preference; and restrictions on employability. Results are reported i n Tables 9 to 13. 42 TABLE NUMBER AND PERCENTAGE DISTRIBUTION ACCORDING TO FUTURE EMPLOYMENT 8 OF INACTIVE NURSE RESPONDENTS PLANS IN NURSING (N=15 3) FUTURE EMPLOYMENT IN NURSING Number Percent Plan to be Employed as Registered Nurse 101 66.0 42 41.6 58 57.4 1 1.0 Full-time Part-time No Response Do Not Plan to be Employed as Registered Nurse 52 34.0 Total 153 100.0 Advantages and Disadvantages of Working as a Registered Nurse Respondents were asked to rank the advantages and disadvantages that would accrue i f they returned to work as a registered nurse. Tables 9 and 10 show the categories and the percentages of respondents who made responses in each category. The most frequently used categories w i l l be discussed. Time conflicts with family ac t i v i t i e s were perceived as the major disadvantage of employment as a registered nurse by 42.5 percent of the respondents. Professional maintenance would be the most important advantage of working for.36.6 percent of the respondents while profession-al advancement was assigned a relatively low priority. Only six (3.9 percent)of the respondents indicated that professional advancement would be the prime advantage to working as a registered nurse. The findings of this study are consistent with Cleland's hypothesis that married nurses 43 TABLE 9 NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS SHOWING PERCEIVED ADVANTAGES OF WORKING AS A REGISTERED NURSE (N=153) PERCEIVED ADVANTAGES OF WORKING AS R.N. Number Percent Nursing Factors 106 69.3 Profe s s i o n a l maintenance 56 36.6 Personal f u l f i l l m e n t 31 20.3 Contribution to others 13 8.5 Interaction with health personnel 0 0.0 Professional advancement 6 3.9 Fi n a n c i a l Security 28 18.4 Mental Stimulation 11 7.2 Soc i a l Contacts 1 0.6 Other 1 0.6 No Response 6 3.9 Total 153 100.0 44 T A B L E 10 NUMBER AND P E R C E N T A G E D I S T R I B U T I O N OF I N A C T I V E NURSE RESPONDENTS SHOWING P E R C E I V E D D I SADVANTAGES OF WORKING AS A R E G I S T E R E D NURSE (N=153) PERCEIVED DISADVANTAGES OF WORKING AS R.N. Number Percent Time Competition - less time for: 65 4 2 . 5 Immediate family Household activities Social, community and personal acti v i t i e s 56 3 6 3 6 . 6 2 . 0 3 . 9 Frustrations Associated with Nursing 32 2 0 . 9 Too much responsibility/not enough time and authority Inadequate nursing knowledge Tasks unrelated to nursing care Unsatisfactory standards of patient care 1 2 11 1 8 7 . 9 7 . 2 0 . 6 5 . 2 Dissatisfaction with Employment Conditions 45 2 9 . 5 Poor pay - cost di f f e r e n t i a l Hours of work Rotating shifts Poor personnel policies 3 11 31 0 2 . 0 7 . 2 2 0 . 3 0 . 0 Health Problems 1 0 . 6 Other 2 1.3 No Response 8 5 . 2 Total 1 5 3 1 0 0 . 0 45 w i l l most often pursue work goals which focus upon maintenance of existing s k i l l s rather than advancement or growth (Cleland, et a l . 1970, p.451). Respondents expressed considerable dissatisfaction with employment conditions, particularly hours of work and rotating shifts. Forty-two (27.4 percent) of the respondents indicated that these two factors would constitute a major disadvantage to working as a registered nurse. Frustrations associated with nursing work i t s e l f were presented as a negative force on employment by 20.9 percent of the respondents. The powerful negative consequences of working as a registered nurse a perceived by the respondents in this study must be offset by positive rewards i f a married nurse i s to resume active status, but evidence of this i s lacking in the data provided. On balance i t would appear that the disadvantages outweigh the advantages. Apart from the advantages pertaining directly to nursing (nursing factors), the remaining positive rewards of employment could conceivably be achieved in other work r settings. In the absence of evidence of a strong professional commitment, i t i s suggested that for nurses in this study, the goal of employment in nursing may be secondary to the goal of employment in any job that provides an opportunity for personal fulfillment and a competitive salary. Date of Employment Respondents were very uncertain of the date they might re-enter the nursing work force; 71.3 percent did not respond at a l l . Part of the reason for such a low response rate may be associated with.the admission procedures of the specific refresher course in which the respondents were interested. Prospective candidates are given written notice of a new course and applications are then accepted on a first-come, first-served 46 basis. Courses tend to f i l l very quickly and many respondents expressed frustration with a system that relies entirely on a telephone c a l l . Obviously the date refresher course candidates return to work in nursing i s highly dependent upon the date they are accepted in a refresher course and neither can be predicted with any degree of certainty. Location The distribution of the 101 respondents who indicated that they planned to return to work as registered nurses according to the geo-graphic area in which they wished to be employed is presented in Table 11. As might be expected, a majority (74.3 percent) would seek employment as registered nurses within the area served by the educational institution from which the sample was obtained. This is also the area where more than 70 percent of the vacant positions for nurses with general prepara-tion were known to exist (Division of Health Services Research and Development 1980). Further analysis of the data, however, shows that the actual manpower potential for the area is limited to nurses who would prefer part-time employment. Of the 75 respondents who indicated they would seek employment in the metropolitan area served by the educational institution from which the sample was drawn, 72 percent indicated that they would prefer part-time employment. Twelve (11.9 percent) of the respondents indicated they would be seeking employment in areas where there were no reported d i f f i c u l t - t o - f i l l positions (Division of Health Services Research and Development 1980). While i t is acknowledged that the situation with regard to vacant positions in nursing i s not static, but changes from month to month, the findings of this study do point to the need for co-ordination between 47 TABLE 11 NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS (PLANNING TO RESUME EMPLOYMENT AS R.N.) (N=101) SHOWING EMPLOYMENT PREFERENCE, REGIONAL HOSPITAL DISTRICT AND PERCENTAGE DISTRIBUTION OF DIFFICULT-TO-FILL POSITIONS. REGIONAL HOSPITAL DISTRICT Percentage Number of Percent Distribution of Respondents D i f f i c u l t - t o - f i l l positions* Greater Vancouver 74.1 75 74.3 Capital 8 7.9 Fraser Valley 1.2 5 4.9 Okanagan 4 4.0 South-East 3.5 0 0.0 Island - Coast 2.4 0 0.0 Central 1.2 1 1.0 North-Central 16.5 2 2.0 North 1.2 o - 0.0 No Response 6 5.9 Total 100.0 101 100.0 * D i f f i c u l t - t o - f i l l positions for nurses with general preparation as reported by the Health Manpower Research Unit in June, 1980. 48 nursing education and nursing administration with respect to nurse manpower planning. C l i n i c a l Preference Table 12 shows the distribution of the respondents in the study who plan to be employed as registered nurses, according to type of health care agency in which they would prefer to be employed and according to c l i n i c a l preference for those respondents who indicated they would prefer to be employed in a general hospital. A majority (81.2 percent) indicated they would prefer employment in a general hospital. Of this number, 45.1 percent would prefer medicine or surgery, while 14.6 percent would prefer extended care nursing. Many of the respondents (40.3 per-cent) indicated they would prefer to be employed in specialty areas such as pediatrics and obstetrics, areas for which the refresher course does not adequately prepare them. These findings may reflect a lack of sufficient information about refresher courses, but also provide evidence of a very real problem for returning nurses. It seems reasonable to assume that a nurse who has worked in a specialty area prior to becoming inactive would want to return to a work situation that i s familiar and, in many cases, for which the nurse has special preparation, yet the only option open to these nurses i s a course that prepares them to function in adult medical, surgical and extended care settings. The situation could well arise where a nurse may enroll i n a refresher course but be dissatisfied with the employment options available and then decide either to remain inactive or to seek alternate employment. 49 TABLE 12 NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS (PLANNING TO RESUME EMPLOYMENT AS R.N.) ACCORDING TO CLINICAL PREFERENCE (N=101)* CLINICAL PREFERENCE Number Percent of Total Respond-ents General Hospital 82 81.2 Medicine 15 Surgery 22 Extended Care 12 Obstetrics (including Newborn Nursery) 16 Pediatrics 8 Other 9 Home Care 5 4.9 Community Health 5 4.9 Physician's Office 9 8.9 Other 15 14.8 Note: Numbers do not sum to 101 as several respondents indicated more than one preference. 50 Restriction on Employability Respondents who stated they planned to resume employment in nursing also indicated that they would require a number of conditions to be met i f they did so. The results are summarized in Table 13. Aside from a preference for part-time employment discussed earlier, the restriction that occurred most frequently was with respect to length of shi f t . Thirty-seven (36.6 percent) of the respondents stated they would expect to work eight hour shifts only. Perhaps because 12 hour shifts are a f a i r l y recent innovation, this finding was not reported i n the earlier studies. Married nurses with children may feel 12 hours is too long to be away from their families. For those who would require child care, they may also have found that few, i f any, child care centers accommodate children for an extended day. Other restrictions mentioned are consistent with those that would be expected from women with another primary role. Employment as a registered nurse would be subject to suitable child care arrangements for 29.7 percent of the respondents. The findings that some respondents (21.8 percent) would be available only during the school year and would limit their employment to day shift only (20.8 percent), further reduces the manpower potential of this group of nurses. Alternate Plans The 53 respondents who stated that they did not plan to work in nursing upon completion of a refresher course continue to view employment in nursing as an option for the future. The future plans for this group of respondents are shown in Table 14. Sixteen (28.3 percent) of the respondents indicated they would become employed in nursing only i f i t became a "financial necessity," while 15 (28.3 percent) would become 51 TABLE 13 NUMBER AND PERCENTAGE OF INACTIVE NURSE RESPONDENTS (PLANNING TO RESUME EMPLOYMENT AS R.N.) ACCORDING TO RESTRICTIONS ON EMPLOYMENT (N=101)* RESTRICTION ° Number Percentage of Total Respond-ents Eight hour shift only 37 36.6 Subject to arranging suitable child care 30 29.7 During school year only 22 21.8 Day shift only 21 20.8 Days/evenings only 21 20.8 Week-days only 14 13.9 Subject to availability of transportation 9 8.9 Days/nights only 6 5.9 No statutory holidays 5 5.0 Week-ends only 5 5.0 Twelve hour shifts only 3 3.0 Nights only 3 3.0 Evenings only 2 2.0 Evenings/nights only 1 1.0 No restrictions 14 13.9 Other 5 5.0 Note: Numbers do not sum to 101 as some respondents indicated more than one restriction 52 TABLE 14 NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS (NOT PLANNING TO RESUME EMPLOYMENT AS R.N.) ACCORDING TO FUTURE PLANS IN NURSING (N=52) FUTURE PLANS IN NURSING Number Percent Employment at some future date Other Total 15 28.8 Employment i f financial necessity 15 28.8 Continue education 13 25.0 9 17.4 52 100.0 employed as a registered nurse at some unspecified time "in the future". Thirteen (24.5 percent) stated they would "continue their education" upon completion of the refresher course. Continuing education in this instance was thought to mean either in a post-basic specialty i f av a i l -able, or in a baccalaureate program. Both usually require recent c l i n i c a l nursing experience as a prerequisite for admission, a require-ment that could conceivably be met through a refresher course. 53 D. Comparison of Subsamples One objective of this study was to describe the differences, i f any, between those nurses in the sample who planned to return to work in nursing and those who planned to remain inactive. Two subsamples of respondents were identified for this step of the data analysis: nurses who planned to resume active status (study group, N=101); and nurses who planned to remain inactive (comparison group N=52). Previous studies of inactive nurses have suggested that a married nurse's decision to be employed in nursing is influenced by a number of personal and work-related variables. To test for a difference between groups, contingency tables were constructed for the variables marital status, age, age of youngest child and annual family income and the chi-square s t a t i s t i c applied (see Appendix F). Results were tested against an alpha criterion of p<.05. The results of data analyses failed to identify any factors which distinguished respondents in the study who plan to resume active status in nursing upon completion of a refresher course from those who planned to remain inactive. E. Employed Nurses The assumption that nurses who express an interest in a refresher course are by definition not active in nursing is refuted by the results obtained in this study. While i t was not a purpose of this project to report on the characteristics and employment plans of respondents who were employed as registered nurses at the time they completed the 54 questionnaire, the fact that 46 (23.1 percent) of the respondents were employed as registered nurses warrants a brief comment. From data collected in this study, there is no way to determine the reasons why employed nurses would take a refresher course. One possibility i s that as nursing roles become increasingly specialized, mobility within the profession becomes increasingly restricted. Nurses who want to change jobs may find they lack the knowledge and s k i l l s necessary to function in another area of nursing and look to a refresher course as a means of enhancing their mobility within the profession. Further investigation i s needed to determine the educational needs of this group of employed nurses and to assess whether or not a refresher course is the appropriate means for meeting these needs. CHAPTER V SUMMARY AND CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS Summary At the time this study was initiated evidence indicated that an inadequate supply of registered nurses existed in British Columbia. At the same time, a significant number of graduate nurses were known to be voluntarily inactive in nursing. It was suggested that some of these nurses might return to active practice in nursing, but because of changes in medicine and in nursing, they would require a refresher course before they could do so. The study had two purposes. The first purpose was to describe the characteristics of graduate nurses who had expressed interest in a refresher course for graduate nurses. The second purpose was to deter-mine the extent to which these nurses were a potential source of nurse manpower supply. A descriptive study was carried out using a mail-back questionnaire as the data-collection tool. The questionnaire used was developed by the investigator. The study sample consisted of 410 graduate nurses who had placed their names on the mailing l i s t for a refresher course for graduate nurses at one educational institution located in a large metropolitan area. One hundred and ninety-nine respondents (for a response rate of 49 percent) participated in the study. 55 56 The data were tabulated under three categories: respondents who were employed as registered nurses (N=A6); respondents who were inactive in nursing but who planned to resume active status upon completion of a refresher course (N=101); and respondents who were inactive in nursing and planned to remain inactive upon completion of a refresher course (N=52). The main focus of the analyses was the data from 153 question-naires returned by inactive nurses. Characteristics of inactive nurses. A graduate nurse who most closely resembles the majority of graduate nurses who participated i n the study would be married and over AO years of age. Her youngest child would be of school age and annual family .income would be over $20,000. She would be registered or eligible for registration as a nurse in British Columbia. A basic diploma in nursing would be her highest educational qualification. She would have graduated from a basic nursing education program more than 10 years ago and have been employed full-time in nursing for three or less years. Reasons for taking a refresher course. The primary reason for taking a refresher course would be to update nursing knowledge and s k i l l s . To a lesser extent, respondents in the study indicated they would take a refresher course in order to obtain British Columbia registration and to become "employable" in nursing. Future employment. Professional maintenance would be the most important advantage to working as a registered nurse for the majority of respondents in this study. Time scheduling conflicts with immediate family a c t i v i t i e s would be the greatest deterrent to returning to work as a registered nurse. The respondents perceived the disadvantages that were directly associated with the unique demands of the profession to 57 outweigh the advantages of working as a registered nurse. A majority of the inactive nurses i n the study (66 percent) plan to resume employment as registered nurses upon completion of the course. For those who do plan to resume active status, a preference was expressed for part-time employment in a general hospital within the metropolitan area served by the educational institution from which the study sample was obtained. Employment would also be conditional upon the avai l a b i l i t y of eight hour (as opposed to 12 hour) shifts and suitable child-care f a c i l i t i e s . To a lesser extent, employment as a registered nurse would be restricted to day shifts and week-days during the school year. Predictors of employment. Analysis of the data supplied by the respondents in this study who were inactive in nursing failed to identify any factors which distinguished nurses who planned to resume active status in nursing from those who planned to remain inactive. Application of the chi-square s t a t i s t i c to contingency table data for the variables marital status, age, age of youngest child and annual family income did not reveal a significant difference i n distribution between groups. Employed nurses. Forty-six of the respondents (23.1 percent) were employed as registered nurses at the time they completed the questionnaire. Data did not permit the determination of the reasons why employed nurses would take a refresher course. Conclusions The findings of this study suggest the following conclusions: 1. Graduate nurses who express interest in a refresher course for graduate nurses are not representative of the population of inactive nurses. Rather, they constitute a population of both inactive and 58 active nurses. A comparison of the findings of this study with those of earlier studies with respect to the characteristics of inactive nurses suggests that inactive nurses who express interest in a refresher course are older, have older children and completed their basic nursing education earlier than the population of inactive nurses. 2. The extent to which inactive nurses in the study sample represent a potential source of nurse manpower i s limited by a prefer-ence for part-time employment and conditional upon suitable hours and the availability of child-care. Implications Although the findings of this study are limited by a low response rate and by an absence of follow-up of non-respondents, they strongly suggest that occupational obsolescence as a consequence of being inactive i n the profession i s a concern of inactive nurses. In addition, the results indicate that a significant number of inactive nurses would resume employment as registered nurses i f certain conditions could be met. These findings have implications for nursing education and for nursing administration. Implications for Nursing Education The factor of occupational obsolescence as a consequence of inactivity in nursing was a major concern of respondents in this study, a concern which was independent of future employment plans i n nursing. In other words, nurses who express interest i n a refresher course do so primarily out of a desire to update their nursing knowledge and s k i l l s rather than out of a desire to be employed as registered nurses. 59 Refresher courses for graduate nurses in British Columbia have, for the most part, been designed to alleviate c r i t i c a l shortages of registered nurses, when and where the shortages occur. Few systematic efforts have been made to orient the inactive nurse to modern nursing practice. Cooper's observation (in 1971) that, "For the most part, organized nursing has not been cognizant of the great interest of many inactive nurses in their profession" (Cooper 1971, p.27), appears to be as valid to-day as i t was a decade ago. To meet the ever increasing need for well-prepared nursing personnel, a more systematic pattern of continuing education is desirable whereby nurses can continue to relate to their profession during periods of inactivity. As long as nursing i s a predominantly female profession, many of it s members w i l l have interrupted careers. For the nurse who l e f t nursing more than 10 years ago, certainly a ref resher course i s desirable. The inactive nurse in the f i r s t few years of inactivity, however, does not need "refreshing" but she does need continuing education i f she is to remain professionally current. Present programs in continuing education for nurses tend to be designed for currently employed nurses. Nursing education has been slow to recognize the need to provide opportunities for nurses to continue their education during periods of inactivity. There are a variety of ways in which such continuing education programs could be implemented, including the use of programmed learning materials and/or the use of interractive television. While provision of up-to-date information w i l l help to minimize the development of a knowledge gap, c l i n i c a l practice i s also of great import-ance in maintaining competence. Short-term preceptorships with a desig-nated resource person could be made available in a variety of health care 60 agencies, thus providing an opportunity for the inactive nurse to integrate knowledge with practice in a c l i n i c a l area of choice. The importance of the attitudes of nurses towards their profession cannot be denied. Since many of these attitudes are formed during the basic education program, nurse educators should be v i t a l l y concerned that students are introduced to the concept of lifelong learning for professional practice. Career planning i s an important aspect of pro-fessional commitment and includes planning for inactivity as well as for professional advancement. Implications for Nursing Administration The results of this study also have implications for nursing administration. For the employer who would consider employing part-time married nurses, there would appear to be a ready supply available from the pool of inactive nurses who have expressed interest in a refresher course. Traditionally nursing has depended upon single or married women without children to meet staffing requirements. Women with children have tended to withdraw from the nursing work force, in part to f u l f i l l their roles as wives and mothers, but also because they have been unable to arrange schedules that do not conflict with family a c t i -v i t i e s . Many of these nurses are now expressing a desire to resume practice as registered nurses but find full-time practice and rotating shifts incompatible with family l i f e . Findings of this study suggest that inactive nurses with family responsibilties are motivated to contribute to nursing, but their contri-bution i s subject to certain conditions, at least for the period they have committed to raising a family. For nursing administration to deny 61 these individuals access to the nursing work force because of a set of rigid expectations regarding availability, or because of the costs of benefits that must be paid to part-time employees, i s to deny the high cost of preparing professional nurses for voluntary inactivity and to limit access to a large pool of educated, experienced nurses. Another important consideration i s that while the majority of nurses in this study indicated they would prefer part-time employment at the moment, the possibility that as family responsibilities lessen, employment may be extended to full-time i n the future further strengthens the case for employing part-time nurses. -Administrative actions that f a c i l i t a t e part-time employment can help nurses to remain professionally current during periods when they have another primary role, and in the long term, help to ensure a supply of experienced, full-time nurses for the future. Recommendations for Further Study On the basis of the findings and implications of this study, i t is recommended that: 1. A study be carried out to determine the extent to which inactive nurses return to practice following the completion of a refresher course and the length of time they remain in the nursing work force. 2. A longitudinal study be initiated in Bri t i s h Columbia that i s designed to follow a cohort of nurses from the time they enter a nursing education program through their working lifetime to determine the career patterns and concomitant, continuing education needs of registered nurses. 62 3. A follow-up study be c a r r i e d out of employed nurses who express i n t e r e s t i n a refresher course to determine t h e i r continuing education needs and the most appropriate means by which these needs could be met. 4. E f f o r t s be directed to planning educational programs that are s p e c i f i c a l l y designed to meet the continuing education needs of nurses during periods of voluntary i n a c t i v i t y . 5. Nursing administrators develop employment p o l i c i e s that acknowledge the p o t e n t i a l contribution of part-time nurses to q u a l i t y patient care. 63 BIBLIOGRAPHY Altman, S.H. 1971. Present and future supply of registered nurses. U.S. Department of Health, Education, and Welfare, National Institutes of Health, Division of Nursing. Anderson, Allan C., and Viko, Janet L. 1967. A low-budget, cooperative plan for seeking out inactive nurses. Hospitals, Journal of the  American Hospital Association Al:11:54-57. Anderson, Helen. 1968. Refreshed w i l l work part time. American Journal  of Nursing 68:10:2188-90. Barker, Anna E., and Staton, Earl E. 1965. Inactive nurses an untapped recruitment source. Public Health Reports. U.S. Department of Health, Education, and Welfare 80:6:637-45. Bateson, Helen. 1980. Hospitals crippled by nursing shortage. The Province. Vancouver: 13 July. Bayer, A.E. 1967. Nurse supply: i t ' s better than we thought. Modern Hospital 109:1:75-79. Benham, Lee. 1971. The labor market for registered nurses. Review of  Economics and Statistics 53:3:246-52. Bergman, Rebecca. 1975. Nursing manpower: issues and trends. Journal  of Nursing Administration 5:5:21-25. Bognano, M.F.; Hixon, J.S., and Jeffers, J.R. 1974. The short-run supply of nurse's time. Journal of human Resources 9:1:80-94. Brief, Arthur, P. 1976. Turnover among hospital nurses: a suggested model. Journal of Nursing Administration 6:10:55-58. Brophy, Selma F. 1974. The R.N. problem: returning to active practice. Journal of Nursing Administration 4:7:45-48. Buchan, Irene. 1966. A study of inactive nurses in Alberta, Canada. Master's Thesis. University of Washington, Seattle, Washington. Canadian Nurses Association. 1980. Annual meeting roundup. Canadian  Nurse 76:7:6-11. Canadian Nurses' Association. 1980. Putting "health"into health care. Ottawa: Canadian Nurses' Association. Canadian Nurses' Association. 1962. Submission to the Royal Commission on health services. Ottawa: Canadian Nurses Association. Catania, J.J. 1964. Why do nurses change jobs? Hospital Management 98:2:93-94. 64 Cleland, Virginia S. 1970. Role bargaining for working wives. American Journal of Nursing 70:6-1242-46. Cleland, Virginia; Bass, Alan R. ; McHugh, Norma, and Montano, Jocelyn. 1976. Social and psychologic influences on employment of married nurses. Nursing Research 25:2:90-97. Cleland, Virginia; Bellinger, Arthur: Shea, Fredericka, and McLain, Sr. Rosemary. 1970. Decision to reactivate nursing career. Nursing Research 19:5-446-52. Cooper, Signe S. 1967. Activating the inactive nurse: a historical review. Nursing Outlook 15:10:62-65. . 1971. From retired to rehired. Journal of Nursing Administration 1:1_: 24-28. Corwin, R.G. 1961. Role conception and career aspiration: a study of identity in nursing. Sociology Quarterly 2:2:69-86. Dauw, Dean C. 1966. Human factors outrank salary as turnover cause in this hospital. Hospital Topics 44:8:65-67. Division of Health Services Research and Development. 1981. Rol l c a l l  Update 80. A status report of selected health personnel in the province of British Columbia. Vancouver: The J.F. McCreary Health Sciences Centre, University of British Columbia. . July 1980. D i f f i c u l t - t o - f i l l positions survey. Vancouver: The J.F. McCreary Health Sciences Centre, University of Bri t i s h Columbia. DuGas, Beverly Witter. 1971. Nursing resources in Canada. Ottawa: Health Manpower Directorate, Department of National Health and Welfare. F l i n t , Robert T., and Spensley, Karen C. 1969. Recent issues in nursing manpower: a review. Nursing Research 18:3:217-29. Foerst, Helen V., and Gareau, Florence E. 1972. Planning for nursing needs and resources. Bethesda Md: U.S. Department of Health, Education and Welfare. Fr a l i c , Shelley. 1980. Lack of glamour one of reasons for chronic nurse shortage. Vancouver Sun. Vancouver: 24 July. Hover, Julie. 1975. Diploma vs degree nurses: are they alike? Nursing Outlook 23:11:684-87. Imai, H. Rose. 1970. The employment picture for nurses in Canada. Ottawa: Canadian Nurses' Association. James, Valerie. 197 9. Nursing shortage hits hard. Nursing Forum 18:4:333-39. 65 K a l i s h , Beatrice., and K a l i s h , P h i l i p . 1979. Nursing shortage? Yes! American Journal of Nursing 79:3:470-78. Keaveny, Timothy J . , and Hayden, Robert L. 1978. Manpower planning for nurse personnel. American Journal of Public Health 68-7:656-61. Kerlinger, Fred. 1973. Foundations of behavioral research. 2nd ed. Toronto: Holt, Rinehart and Winston Inc. Kermacks, C l a i r e . 1979. Nursing education study report. V i c t o r i a : B r i t i s h Columbia M i n i s t r y of Education, Science and Technology. Knopf, L u c i l l e . 1979. Nurse career pattern study: baccalaureate degree nurses ten years a f t e r graduation. H o s p i t a l Topics 57:5:5-9. Knopf, L u c i l l e . 1975. R.N.'s: one and f i v e years a f t e r graduation. New York: National League f o r Nursing. Kramer, Marlene. 1974. R e a l i t y Shock: why nurses leave nursing. St. Louis: C.V. Mosby Co. Krueger, J a n e l l e C. 1971. The education and u t i l i z a t i o n of nurses. A pardox. Nursing Outlook 19:10:676-79. La V i o l e t t e , Suzanne. 1979. Nurse incentives stay despite spotty r e s u l t s . Modern Healthcare 9:11:69-70. Levine, Eugene. 1978. Nursing supply and requirements: the current s i t u a t i o n and future prospects. In P o l i t i c a l , Social and educational  forces on nursing: impact of p o l i t i c a l forces. New York: National League for Nursing. Link, Charles, R., and S e t t l e , R u s s e l l . 1980. F i n a n c i a l incentive and labor supply of married p r o f e s s i o n a l nurses: an economic a n a l y s i s . Nursing Research 29:4:238-43. Marshall, Melody J . , and Bruhn, John G. 1967. Refresher courses and r e a c t i v a t i o n of nurses. Nursing Outlook 15:1:59-61. Mayberry, Minerva A. 1967. Are nurse refresher programs worthwhile? Hospitals, Journal of American Hospital A s s o c i a t i o n 41:June 1:95-100. Moore, Joan F. 1979. Nursing shortage: a question of numbers or of management? Ho s p i t a l Forum 22:6:15-17. Murray, V.V. 1970. Nursing i n Ontario. Toronto: Queen's P r i n t e r . f, Mussallem, Helen K. 1965. Royal commission on health services: nursing  education i n Canada. Ottawa: Queen's P r i n t e r . Nie, Norman H.; H a l l , Hadlai C.; Jenkins, Jean G.; Steinbrenner, Karin, and Bent, Dale H. 1975. SPSS: S t a t i s t i c a l package f o r the S o c i a l Sciences. 2nd ed. New York: McGraw-Hill Book Co. 66 Noelle-Neuman, E. 1970. Wanted: rules for wording structured question-naires. Public Opinion Quarterly 34:191-201. Platou, Carl M., and Pederson, Dennis W. 1967. Can more part-time nurses be recruited. Hospitals, Journal of the American Hospital  Aassociation 41:Mayl6:72-82. Polit, Denise F., and Hungler, Bernadette P. 1978. Nursing research: principles and methods. Toronto: J.B. Lippincott Company. Reese, Dorothy E.; Siegal, Stanley E., and Testoff, Arthur. 1964. The inactive nurse. American Journal of Nursing 64:11:124-27. Reese, Dorothy E.; Sparmacher, D. Ann, and Testoff, Arthur. 1962. How many caps went on again? Nursing Outlook 10:8:517-19. Registered Nurses' Association of British Columbia. 1980. Annual Report. Vancouver: Registered Nurses' Association of B.C. Registered Nurses' Association of British Columbia. 1980. Qualifying, refresher courses approval process explained. RNABC News 12:3:3. Registered Nurses' Association of British Columbia. 1973. Registered  nurse manpower in British Columbia. Vancouver: Registered Nurses' Association of B.C. Royal Commission on Health Services Vol. II. 1965. Ottawa: Queen's Printer. Saskatchewan Department of Health. 1975. Final report of nursing supply  conference. Research and Planning Branch. Saskatchewan Department of Health. Stambler, Howard V. 1979. Health manpower for the nation - a look ahead at the supply and the requirements. Public Health Reports 94:1:3-10. Statistics Canada. 1978. Nursing in Canada: Canadian nursing s t a t i s t i c s , 1977. Ottawa: Minister of Industry, Trade and Commerce. Swanberg, Gloria, and Knutson, Christina. 1979. Increasing nurse demand highlights need for long-range recruiting plans. Modern  Healthcare 9:11:68-70. Treece, Eleanor Walters. 1977. Elements of research in nursing. 2nd ed. St. Louis: C.V. Mosby Co. Wandelt, Mabel A.; Pierce, Patricia M., and Widdowson, Robert R. 1981. Why nurses leave nursing and what can be done about i t . American  Journal of Nursing 81:1:72-77. White, Charles H. 1979. Nursing shortage, turnover and some proposed solutions. Hospital Forum 22:6:10-13. Woman's Bureau - 1965. Facts and f igures about women In the labour  f o r c e . Ottawa: Woman's Bureau, Canada Department of Labour, Queen' P r i n t e r . Woman's Bureau. 1964. Women at work i n Canada: Department of Labour Queen's P r i n t e r . Woman's Bureau. 1978. Women i n the labour f o r c e : f ac t s and f i g u r e s . Part 1: labour force a c t i v i t y . Ottawa: M i n i s t e r of Supply and Serv ice s , Queen's P r i n t e r . Woolley, Alma. 1966. Inactivitis. American Journal of Nursing66:12: 2661-63. APPENDIX A LETTER OF AGREEMENT APPENDIX B REFRESHER COURSE QUESTIONNAIRE DIRECTIONS 1. Please read each question and its instructions carefully. 2. If you feel that a question is di f f i c u l t for you to answer, please check the response which is closest to that which you feel is cor-rect, or use the response "other" where i t is provided and specify your reason for doing so. 3. Please do not sign the questionnaire. Anonymity is assured, and your responses w i l l not influence your future application for a refresher course. SECTION 1. 1. Marital Status: f_ 2. What is your age? | | Under 25 [ f 25 - 29 [ | 30 - 34 | | 35 - 39 Single | [ 40 - 44 3. Age of youngest child (if applicable) | | Under 5 years | | 5 - 9 years | | 10 - 14 years 4. Estimate of annual family income: | | Less than $10,000 per year [ ) $10,000 to $19,000 per year [ | $20,000 to $29,000 per year | | $30,000 per year and over Married ] | 4 5 - 4 9 | | 50 - 54 1 t 5 5 - 5 9 | [ 60 - 64 J Other 15 - 17 years | | 18 years and over 72 SECTION I i 5. L i s t basic and post-basic nursing education, where taken ( c o l l e g e , t e c h n i c a l school, h o s p i t a l , u n i v e r s i t y ) , and when completed. L i s t b asic nursing education f i r s t . Diploma C e r t i f i c a t e or Degree Spec i a l t y ( i f a pplicable) Type of I n s t i t u t i o n Date Completed Example :Bo&-ic J Poit BoA-ic 7 2 diploma. - R .N. Diploma. Degree - B .S .N. n/a. O.K. NuAAing n/a Hospital TexihnicAl School 7959 796S 1970 Basic 1 Post-Basic 1 2 3 6. L i s t academic preparation beyond high school i n f i e l d s other than nursing ( i f a p p l i c a b l e ) , where taken, (type of i n s t i t u t i o n ) , and when completed. L i s t only courses or programs of s i x months duration or longer. Diploma C e r t i f i c a t e or Degree Subject or S p e c i a l t y Type of I n s t i t u t i o n Date Completed 1 2 3 A SECTION I I I 7. What i s your present R e g i s t r a t i o n status? Registered i n B r i t i s h Columbia? 1 | No | | Yes I f yes, | |. P r a c t i s i n g | [ Non-practising I f no, | | Resigned i n good standing i n B.C.? | 1 Never registered l n B.C. Are you Registered i n another Province or Country? | | No | j Yes I | Other (specify) 8. Are you cu r r e n t l y e l i g i b l e f o r R e g i s t r a t i o n as a nurse i n B r i t i s h Columbia? | | No | | Yes 73 SECTION I I I Continued 9. Are you required to complete a Refresher Course for R e g i s t r a t i o n as a nurse i n B r i t i s h Columbia? No I I Yes 10. Are you presently employed as a Registered Nurse? | | Part-time I | Casual | | Not employed Fu l l - t i m e (35 hrs/week or more) (less than 35 hrs./week) as an R.N. I f employed as a Registered Nurse, state job t i t l e : I f not employed as a Registered Nurse, check one of the f o l l o w i n g : I am cu r r e n t l y unemployed and not seeking employment as an R.N. ~| I am cu r r e n t l y unemployed and seeking employment as an R.N. ~| I am cu r r e n t l y unemployed and seeking employment as an R.N., but r e s t r i c t e d because of lack of opportunity to update myself. "| I am cu r r e n t l y employed other than as an R.N., and not seeking employment as an R.N. "| I am currently employed other than as an R.N., but would p r e f e r employment as an R.N. J i a cu r r e n t l y employed other than as an R.N., would pr e f e r employment as an R.N. but am r e s t r i c t e d because of a lack of opportunity to update myself. 11. Have you been employed i n a nursing or health r e l a t e d p o s i t i o n i n a capacity other than as a Registered Nurse since completing your basic nursing education? For example, as a graduate, (non-registered) nurse, or p r a c t i c a l No L J Y e s I f yes, please describe-below, l i s t i n g most recent employment f i r s t . Job T i t l e No. of yrs i n p o s i t i o n F u l l -time P a r t -time Casual Date of leaving Reason fo r l eaving 1 J . . o / . o J. U. 74 SECTION I I I Continued 12 Have you been employed i n a non-nursing or non-health r e l a t e d p o s i t i o n since completing your basic nursing education. Job T i t l e No of yrs i n job F u l l -time Part-time Casual Date of leaving Reason fo r l e a v i n g 1. 2. J . 4. 13. Have you worked as a volunteer since completing your b a s i c nursing education? \Z3 N° EU Yes I f yes, i n what capacity and f o r how long? Name of Agency or T i t l e No. of years Date of Leaving Reason f o r leaving None | | Less than 1 year | [ 1 - 3 years | [ 4 - 7 years Date l a s t employed f u l l - t i m e as an R.H. | | 8 - 1 1 years 12 - 15 years j | more than 15 years None 8 - 1 1 years | | Less than 1 year | | 1 - 3 years ] "1 12 - 15 years | |"more than 15 years | | 4 - 7 years Date l a s t employed part-time as an R.N. 75 16. Check a l l f a c i l i t i e s i n which you have been employed as an R.N. Children's H o s p i t a l ] Convalescent/Rehab H o s p i t a l j Educational F a c i l i t y ] Extended Care Hosp i t a l ] General Hospital J Health Unit - Home Care only ] Health Unit - Pub l i c Health Program I | V.O.N. j Mental Health/Community Care Team Nursing Home/Community Care F a c i l i t y Physician's O f f i c e Psychiatric/Mental H o s p i t a l P r i v a t e Duty Research Industry Other (specify) 17. I f you answered General Hospital i n Question 16, please s p e c i f y c l i n i c a l area(s). Medical Unit S u r g i c a l Unit P e d i a t r i c s Obstetrics Psychiatry Central Supply Emergency I.V. Therapy Medical/Surgical Intensive Care Newborn Nursery Operating Room Recovery Room Out-Patient/Ambulatory Care R e h a b i l i t a t i o n Renal D i a l y s i s | | Other (specify) 76 SECTION IV 18. Which THREE of the following reasons f o r taking the Refresher Course are most important to you? Please rank the reasons i n order of importance to you, placing a "1" beside the most important reason, a "2" beside the second most important reason, and a "3" beside the t h i r d most important reason. I f fewer than three, please rank those that are important to you. want to be employed i n nursing to become employable i n nursing a change from present a c t i v i t i e s continue my education i n nursing to gain confidence as a nurse des i r e f o r new learning experiences to obtain B r i t i s h Columbia R e g i s t r a t i o n f o r personal s a t i s f a c t i o n to provide f o r a stable and secure future to earn a l i v i n g to update nursing knowledge and s k i l l s other (specify) A pant-tune. R e ^ e i r t e * Couuz ^OK Gnadwatz Uauzi iM in thz planning itagz. Thz goat it, to make thi& cowue, at, wzll-at, the fiull-timz HzfaziheA Cousue., available, to itadznti in tlit Tali oi 19&0. We w.Lih tc de.iign t!ie ceu/uic tc mzzt ipzcifiic itudznt nzzdi and to accommodate individual li&z&tylzi, th.zn.z-&otiz, we a/iz asking youn. at>iit>tancz in pioviding ai uiith thz following in&onm-ation. 19. Which type of refresher course would BEST meet your s p e c i f i c needs at t h i s time? | | The Fu l l - t i m e ten week course, daytime hours on weekdays as given at present | | Part-time course given over a longer period of time with evening and weekend classes. 1$ juUl-timZ, proceed to question number 26. T{ patit-timz, answer questions 20 to 25; BEFORE proceeding to question 26. 20. Which of the f o l l o w i n g factors influenced you to choose a part-time course? | | c h i l d r e n i n school | | wish to be home during the day 1 | b a b y - s i t t i n g easier to arrange i n the evening and on the weekend | | hold a day-time job • Q | more economical to attend evening/weekend classes | | need a longer period of time to study than allowed i n the f u l l - t i m e course 1 | other (specify) 77 21. Would you be able to p a r t i c i p a t e i n a concentrated c l i n i c a l experience e.g., a two week block, i n the f i n a l weeks of the course? I I No | I Yes I f no, l i s t reasons 22. How long would you expect the part-time course to be? | | s i x t e e n weeks 1 | eighteen weeks r  | | twenty weeks [ | longer, please specify •  23. How could you BEST meet the requirements f o r theory? [ [ attending classes at a regional college | | using correspondence material at home | | attending i n s t r u c t i o n a l and i n t e r a c t i v e t e l e v i s i o n classes at a regional college | | v i a cable t e l e v i s i o n at home [ | other (specify) 24. I f you reside i n a geographic area outside the Lower Mainland how could you BEST complete the c l i n i c a l and laboratory sessions? | | not app l i c a b l e - I l i v e i n the Lower Mainland | | t r a v e l to the Lower Mainland twice during the course f o r c l i n i c a l experience | | use h o s p i t a l f a c i l i t i e s and resource people i n my geographic area | | use i n s t r u c t i o n a l and i n t e r a c t i v e . t e l e v i s i o n f o r demonstration and p r a c t i c e of s k i l l s at my regional college | | other (specify) 78 25. Which of the following times would BEST s u i t your l i f e s t y l e ? For Classes: | | weekdays 9:00 a.m. to 4:00 p.m. | | weekdays 4:00 p.m. to 7:00 p.m. | | weekdays 7:00 p.m. to 10:00 p.m. | 1 Saturdays 9:00 a.m. to 4:00 p.m. [ | Other (specify) .  For Labs: | 1 weekdays 9:00 a.m. to 4:00 p.m. | | weekdays 4:00 p.m. to 7:00 p.m. | | weekdays 7:00 p.m. to 10:00 p.m. | | Saturdays 9:00 a.m. to 4:00 p.m. I 1 Other (specify) For C l i n i c a l P r a c t i c e : | 1 weekdays 5:00 p.m. to 10:00 p.m. 1 | Saturdays 7:30 a.m. to 3:30 p.m. | ] Saturdays 3:30 p.m. to 11:30 p.m. I 1 Other (specify) Tuti-timz and PanX-time. pleji&z animeA thz fallowing: 26. Do you think there are some theory areas that you would l i k e to challenge by w r i t i n g an examination, i n order to determine which classes you are required to attend? I I No I I Yes 79 27. Would you be w i l l i n g to have your basic nursing s k i l l s assessed i n a lab s e t t i n g BEFORE beginning the course? (A p r a c t i s e session would be a v a i l a b l e ) . I | No | | Yes I f not, l i s t reasons 28. Are you able to study independently i . e . , with minimal supervision and d i r e c t i o n ? | | No 1 ' | Yes I f not, l i s t reasons 29. Are you able to evaluate your progress i n a learning s i t u a t i o n ? | | No | | Yes I f not, l i s t reasons 30. How confident are you i n your performance of basic nursing s k i l l s ? (Check only one) | | Can perform basic nursing s k i l l s , but not without constant supervision and some assistance. | | Can perform basic nursing s k i l l s but require periodic super-v i s i o n and/or assistance. | | Can perform basic nursing s k i l l s without supervision and/or assistance. | | Don't know 31. When d i d you put your name on the B.C.I.T. Refresher Course mailing l i s t ? Month Year 32. What has been your experience i n applying for the B.C.I.T. Refresher Course? 1 | Have never applied f o r a s p e c i f i c course | | Telephone l i n e s busy and could not get through | 1 Put on the waiting l i s t but not interviewed | | Interviewed f o r a course and placedon the al t e r n a t e l i s t 1 | Interviewed and accepted f o r a course, but withdrew before course started 1 1 Interviewed but not accepted f o r a course | | Other (specify) 80 SECTION V 3 3 . Do you plan to be employed as a Registered Nurse as soon as you complete the Refresher Course? 3 4 . 3 5 . No \ — J Yes 1j no, proceed to question 3 7 . j/eA,where i n B.C. do you plan to be employed and i n what capacity? Specify: C i t y P o s i t i o n | | F u l l - t i m e 1 I Part-time Date of a v a i l a b i l i t y for employment I f you expect to seek employment i n a General H o s p i t a l for what c l i n i c a l area w i l l you be most l i k e l y to apply? (check one only) 2 Medical Unit ] S u r g i c a l Unit ] P e d i a t r i c s ] Obs t e t r i c s "1 Psychiatry J Emergency Operating Room Recovery Room Out Patient/Ambulatory Care R e h a b i l i t a t i o n Renal D i a l y s i s Other (specify) ] I.V. Therapy J Newborn Nursery | Medical/Surgical Intensive Care I f you do not expect to seek employment i n a General H o s p i t a l , to what f a c i l i t y w i l l you be most l i k e l y to apply (check one only) 1 Children's H o s p i t a l ] Mental Health/Community Care Team J Convalescent/Rehab. Hos p i t a l "] Educational F a c i l i t y J Extended Care Hosp i t a l ] Health Unit - Home Care Health Unit - Preventative Program Industry ] Nursing Home J Physician's O f f i c e 3 P s y c h i a t r i c H o s p i t a l "2 P r i v a t e Duty ~1 Research ~) Other (specify) 81 36. What r e s t r i c t i o n s w i l l you be l i k e l y to place on your employment as a Registered Nurse? Check a l l that apply None Day S h i f t only | | Days & Evenings only Evening S h i f t only Night S h i f t only Days and nights only Evenings & nights only Subject to arranging s u i t a b l e c h i l d care Subject to a v a i l a b i l i t y of transportion Week-ends only | Weekdays only | During "school year" only I No statutory holidays ] 8 hour s h i f t s only ] 12 hour s h i f t s only ] Other (specify) 37. J& you have. an&weAzd question* 34, 35, 36, ptexuz omit question 37 and continue. ulUjn. question 31. When you complete the Refresher Course, do you plan to: | | become employed i n nursing at some future date? | | seek employment.in nursing i f i t becomes a f i n a n c i a l necessity? | 1 continue your education? | | Other (specify) •  38. I f you were to return to work as a Registered Nurse, what THREE advan-tages would you ant i c i p a t e ? Please rank t h e i r importance to you by pl a c i n g a "1" beside the most imporLant to you, a "2" beside the second most important, and a "3" beside the t h i r d most important. I f fewer than 3, please rank those that are important to you. Maintain nursing knowledge and s k i l l s Personal f u l f i l l m e n t C o n t r i b u t i o n to others I n t e r a c t i o n with health personnel P r o f e s s i o n a l advancement F i n a n c i a l s e c u r i t y Mental s t i m u l a t i o n S o c i a l contacts Other (specify) 82 39. "If you were to return to work as a Registered Nurse, what THREE disadvan-tages would you ant i c i p a t e ? Please rank t h e i r importance to you by p l a c i n g a "1" beside the most important to you, a "2" beside the second most important, and a "3" beside the t h i r d most important to you. I f fewer than three, please rank those that are important to you. Less time f o r immediate family Less time f o r household a c t i v i t i e s Less time f o r s o c i a l , community, and personal a c t i v i t i e s Poor pay - cost d i f f e r e n t i a l . Hours of work Rotating s h i f t s Poor personnel p o l i c i e s U n s a t i s f a c t o r y standard of patient care Too much r e s p o n s i b i l i t y without enough time and authority Inadequate nursing knowledge Tasks unrelated to nursing care Health problems Other (specify) . A d d i t i o n a l Comments: THANK YOU FOR YOUR CO.OPERATION IN COMPLETING THIS QUESTIONNAIRE APPENDIX C COVERING LETTER APPENDIX D FOLLOW-UP LETTER APPENDIX E COMMENTS 88 COMMENTS The comments made by 61 respondents are summarized and presented, with examples, in the following pages. Several comments focussed on perceived changes in nursing practice and tended to reflect a degree of ambivalence with respect to the respondent's employment as a registered nurse. For example, one respond-ent stated she found the present standard of patient care "distressing," and another that, "the standard of nursing care certainly has decreased" and a third that "most medical-surgical (nursing) situations are over-worked and understaffed." Respondents also expressed concern for their own capabilities as registered nurses. Fear of failure and of their own a b i l i t y to cope with changes within the profession characterized this group of comments. "I have this terrible thought that I would f a i l because of being out of nursing for so long", was an opinion shared by several respondents. Some expressed concern that they could not complete the academic require-ments of the refresher course, while others f e l t they could never adjust to the technological changes that have occurred i n health care and in nursing. Partial updating, "... whereby older nurses could be retrained enough to staff the extended care units," was suggested as an alter-native to the present requirements. Specialization within nursing and the d i f f i c u l t i e s of resuming active practice as a registered nurse in a specialty area after a period of inactivity was also commented upon. "I am most interested in newborn 89 care and would receive no refresher courses concerned with that type of nursing care." "I worked in a specialty (psychiatry) and i f I go back to nursing I would like to return to this area." "Nursing seems to be becoming more and more specialized and the refresher course is very general." Several respondents proposed modification of the present refresher course format to overcome the d i f f i c u l t i e s of re-entering a specialty area. Typical of the suggestions was, "... to practice a week in area of your choice at the end of the refresher course". The d i f f i c u l t i e s of arranging family schedules to accommodate employment as a registered nurse were described by respondents who had children at home. Many f e l t they could not cope with full-time study or full-time employment without, "sacrificing proper care of our families." A number of suggestions were made with respect to ways in which nurses who saw their f i r s t responsibility to their families could make a contribution to nursing. Examples were: employment during school hours, or f a i l i n g that, more permanent part-time jobs. "Too many hospitals have too few full-time staff and rely on on-call r e l i e f nursing staff to f i l l i n , ... permanent part-time (nurses) on the same shift always take far greater pride in their work and do a better job." The last set of comments related to the specific refresher course in which they were interested, specifically the admission policy, the costs associated with the course and with i t s location. Examples of comments on admission policy were: "The recruitment method ... baffles me;" "I suggest the present (admission) policy ... i s chancy, risky and puts a tremendous strain on (applicants);" and "I sure would like to get as far as having an interview at least." The costs of a refresher course, both direct and indirect, were 90 also commented upon. "The tuition i s prohibitive and discourages me and others." "The average wife and mother who wishes to take the refresher course and return to work must debate the i n i t i a l cost of the course, uniforms, shoes, R.N.A.B.C. (fees) before one can be a wage earner." "I do not object to the principle of updating knowledge, ... but what other group charges so much for what i s given?" "Would like more financial help to be available for single parents who want to go to school to be able to support family better in the future." Respondents also expressed a desire for a refresher course in other areas of the province. "I would be very happy to see a refresher course in Victoria." "I feel recognized courses should be available readily i n more areas of the province." "For most women outside the Lower Mainland, (the present refresher course) i s financially unreal-i s t i c , considering transportation, room and board, tuition, plus baby-sit t i n g for 10 weeks." APPENDIX F CHI-SQUARE ANALYSES OF SELECTED VARIABLES INACTIVE NURSES 92 TABLE 15 NUMBER AND PERCENTAGE DISTRIBUTION OE INACTIVE NURSE RESPONDENTS BY FUTURE EMPLOYMENT PLAN IN NURSING AND MARITAL STATUS (N=153) EMPLOYMENT PLAN IN NURSING MARITAL STATUS Employment as R.N. No employment as R.N. Total Number Percent Number Percent Number Percent Single 5 5.0 4 7.7 9 5.9 Married 86 85.1 42 80.8 128 83.6 Other 10 9.9 6 11.5 16 10.5 Totals 101 100.0 52 100.0 153 100.0 X 2 = .605 p < .05 df = 2 93 TABLE 16 NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS BY FUTURE EMPLOYMENT PLAN IN NURSING AND AGE (N=153) AGE INTERVAL1 EMPLOYMENT PLAN. IN NURSING Employment No employment Total as R.N. as R.N. Number Percent Number Percent Number Percent Under 35 years 35-39 years 40-44 years 45 years and over Totals 19 2 18.8 7 3 13.5 26 17.0 27 26.7 17 32.7 44 28.8 24 23.8 14 26.9 38 24.8 31 4 30.7 14 5 26.9 45 29.4 101 100.0 52 100.0 153 100.0 1. Intervals were collapsed to ensure adequate numbers i n each c e l l . 2. Includes three respondents in 25-29 year interval. 3. Includes one respondent in 25-29 year interval. 4. Includes 13 respondents in 45-49 year interval, nine in 50-54 year interval and four over 55 years. 5. Includes seven respondents in 45-49 year interval, three in 50-54 year interval and four over 55 years. X 2 = 1.306 p < .05 df = 3 94 TABLE 17 NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS (N=138) BY FUTURE EMPLOYMENT PLAN IN NURSING AND AGE OF YOUNGEST CHILD EMPLOYMENT PLAN IN NURSING AGE OF YOUNGEST CHILD Employment as R.N. No employment as R.N. Total Number Percent Number Percent Number Percent Under 5 years 12 13.0 8 17.4 20 14.5 5 - 9 years 33 35.9 10 21.7 43 31.1 10-14 years 26 28.3 16 34.8 42 30.4 15-17 years 10 10.9 5 10.9 15 10.9 18 years and over 11 11.9 7 15.2 18 13.1 Totals 92 100.0 46 100.0 138 100.0 X 2 = 3.042 p < .05 df = 4 95 TABLE 18 NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS BY FUTURE EMPLOYMENT PLAN IN NURSING AND ANNUAL FAMILY INCOME (N=148) EMPLOYMENT PLAN IN NURSING ANNUAL FAMILY INCOME Employment as R.N. No employment as R.N. Total Number Percent Number Percent Number Percent Less than $10,000 6 6.1 4 8.0 10 6.7 $10,000 - $19,000 17 17.4 11 22.0 28 18.4 $20,000 - $29,000 37 37.7 12 24.0 49 33.2 $30,000 and over 38 38.8 23 46.0 .61 41.2 Totals 98 100.0 50 100.0 148 100.0 X 2 = 2.813 p < .05 df = 3 

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0095188/manifest

Comment

Related Items