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

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A DESCRIPTIVE STUDY OF NURSING REFRESHER COURSE CANDIDATES  by SALLY ANNE MACLEAN B.Sc.N., The U n i v e r s i t y  of B r i t i s h Columbia,  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING  in THE FACULTY OF GRADUATE  STUDIES  (School of N u r s i n g )  We a c c e p t t h i s t h e s i s as conforming to the r e q u i r e d  standard  THE UNIVERSITY OF BRITISH COLUMBIA APRIL 1981 © S a l l y Anne MacLean, 1981  1975  In p r e s e n t i n g  t h i s t h e s i s i n p a r t i a l f u l f i l m e n t of  requirements f o r an advanced degree a t the  the  University  of B r i t i s h Columbia, I agree t h a t  the L i b r a r y s h a l l make  it  and  f r e e l y a v a i l a b l e for reference  study.  I further  agree t h a t p e r m i s s i o n f o r e x t e n s i v e copying of t h i s t h e s i s f o r s c h o l a r l y purposes may  be  department or by h i s or her understood t h a t  granted by  representatives.  s h a l l not  be  The U n i v e r s i t y of B r i t i s h 2075 Wesbrook P l a c e Vancouver, Canada V6T 1W5  (2/791  It is  allowed without my  permission.  DE-6  my  copying or p u b l i c a t i o n of t h i s t h e s i s  f o r f i n a n c i a l gain  Date  the head o f  Columbia  written  ii  ABSTRACT The  study had two p u r p o s e s .  The f i r s t purpose was t o d e s c r i b e the  c h a r a c t e r i s t i c s of graduate n u r s e s who had expressed i n t e r e s t r e f r e s h e r c o u r s e f o r graduate n u r s e s .  in a  The second purpose was t o d e t e r -  mine the e x t e n t t o which these n u r s e s were a p o t e n t i a l source o f nurse manpower s u p p l y .  Survey methodology, u t i l i z i n g a mail-back q u e s t i o n n a i r e  developed by the i n v e s t i g a t o r , was s e l e c t e d as the r e s e a r c h approach. The q u e s t i o n n a i r e was completed names on the m a i l i n g l i s t  by 199 n u r s e s who had p l a c e d t h e i r  f o r a r e f r e s h e r c o u r s e f o r graduate n u r s e s a t  one p o s t - s e c o n d a r y e d u c a t i o n a l i n s t i t u t i o n p o l i t a n area. interest  l o c a t e d i n a l a r g e metro-  A n a l y s i s i n d i c a t e d t h a t graduate n u r s e s who express  i n a r e f r e s h e r course a r e n o t s i m i l a r , as a group,  population of i n a c t i v e nurses.  t o the e n t i r e  Rather, they c o n s t i t u t e a p o p u l a t i o n of  b o t h i n a c t i v e and employed n u r s e s .  Nurses i n the study sample were  o l d e r , had o l d e r 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 i n a c t i v e nurses. I t was c o n c l u d e d t h a t the e x t e n t t o which n u r s e s who express interest  i n a r e f r e s h e r course r e p r e s e n t a p o t e n t i a l source o f nurse  manpower supply i s l e s s than might be expected on the b a s i s of numbers alone.  F o r t y - s i x nurses  (23.1 p e r c e n t ) were employed as r e g i s t e r e d  n u r s e s when they completed  the q u e s t i o n n a i r e .  Of the 153 respondents  who were i n a c t i v e i n n u r s i n g , a m a j o r i t y (66 p e r c e n t ) i n d i c a t e d  they  planned t o resume a c t i v e s t a t u s as n u r s e s upon c o m p l e t i o n of a r e f r e s h e r course.  Most, (57.4 p e r c e n t ) would p r e f e r p a r t - t i m e employment and  schedules and  t h a t p r o v i d e f o r a minimum of c o n f l i c t w i t h f a m i l y a c t i v i t i e s  responsibilities. The  study was  l i m i t e d by a low response  r a t e and by an absence of  f o l l o w - u p of non-respondents b u t , g i v e n these l i m i t a t i o n s , the have i m p l i c a t i o n s f o r n u r s i n g e d u c a t i o n and  results  for nursing administration.  iv TABLE OF CONTENTS  Abstract  1  L i s t of Figures  V  L i s t of Tables  1  1  v i i  Acknowledgements  i  x  CHAPTER I  II  INTRODUCTION Context of the problem  1  Statement of the purpose  6  Objectives of the study  6  D e f i n i t i o n of terms  6  Limitations  7  Organization of the study report  8  REVIEW OF RELATED LITERATURE Introduction  III  9  Characteristics of inactive nurses  11  Employment patterns of women  15  Factors a f f e c t i n g employment of nurses  17  Refresher courses for graduate nurses  19  Summary  20  METHODOLOGY Introduction Selection of the Sample  22 •  23  Development of the instrument  23  Pretesting  24  F i n a l Questionnaire  27  R e l i a b i l i t y and v a l i d i t y 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 Reasons for Taking a Refresher Course  ,  , 31 ,  Future Employment i n Nursing Advantages and Disadvantages of Working as a Registered Nurse  41  Date of Employment  45  Location  46  C l i n i c a l Preference  48  42  R e s t r i c t i o n on Employability  V  39  . 50  Alternate Plans  50  Comparison of Sub samples  53  Employed Nurses  53  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  vi  LIST OF FIGURES FIGURE 1  LIST OF VARIABLES  25  2.  REASONS GIVEN BY INACTIVE NURSE RESPONDENTS FOR TAKING A REFRESHER COURSE  40  vii  LIST OF TABLES  1.  NUMBER AND PERCENTAGE DISTRIBUTION OF RESPONDENTS AND NON-RESPONDENTS IN THE STUDY POPULATION  27  2.  NUMBER AND PERCENTAGE DISTRIBUTION OF RESPONDENTS ACCORDING TO EMPLOYMENT STATUS IN NURSING  30  3.  NUMBER AND PERCENTAGE OF INACTIVE NURSES ACCORDING TO MARITAL STATUS, AGE, AGE OF YOUNGEST CHILD AND INCOME  32  4.  NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS ACCORDING TO REGISTRATION STATUS  34  5.  NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS ACCORDING TO HIGHEST EDUCATION IN NURSING AND DATE COMPLETED  6.  7.  8.  9.  10.  11.  12.  ,  35  NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS ACCORDING TO EMPLOYMENT EXPERIENCE AS REGISTERED NURSE  37  NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS ACCORDING TO EMPLOYMENT STATUS (OTHER THAN AS REGISTERED NURSE) .  38  NUMBER AND PERCENTAGE OF INACTIVE NURSE RESPONDENTS ACCORDING TO FUTURE EMPLOYMENT PLANS IN NURSING  42  NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS SHOWING PERCEIVED ADVANTAGES OF WORKING AS A REGISTERED NURSE  43  NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS SHOWING PERCEIVED DISADVANTAGES TO WORKING AS A REGISTERED NURSE  44  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  47  NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS (PLANNING TO RESUME EMPLOYMENT AS REGISTERED NURSE) ACCORDING TO CLINICAL PREFERENCE  49  viii  13.  14.  NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSES (PLANNING TO RESUME EMPLOYMENT AS REGISTERED NURSE) ACCORDING TO RESTRICTIONS ON EMPLOYMENT NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS (NOT PLANNING TO RESUME EMPLOYMENT AS REGISTERED NURSE) ACCORDING TO FUTURE PLANS IN NURSING  '  51  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 f o r  their continuous encouragement, support and patience: Sheila Stanton, chairman, f o r her knowledge and expertise so w i l l i n g l y shared, her e d i t o r i a l comments and friendship; and Annette Stark f o r her i n t e r e s t , guidance and c r i t i c a l appraisal during each phase of the study. I am indebted to the B r i t i s h Columbia I n s t i t u t e of Technology, Department of Health Continuing Education and i n p a r t i c u l a r 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 c o l l e c t i o n phase. Appreciation i s also extended to Kerry Kerluke and Sharon Jansen for their w i l l i n g and expert assistance with computer coding and computer programming. Special thanks go to the nurses who volunteered to p a r t i c i p a t e : their cooperation i n completing the questionnaire was e s s e n t i a l to the successful outcome of the study.  I am also indebted to  Primrose Gontier f o r typing a l l the materials f o r 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 shortage  of n u r s e s  of many p r o v i n c e s  i n Canada a f f e c t e d by  (Canadian Nurse July-August  o f t h i s comes from a number o f s o u r c e s .  The  1980,  pp.  6-10).  a  Evidence  Registered Nurses' A s s o c i a t i o n  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 n u r s i n g p o s i t i o n s 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. in  The  H e a l t h Manpower Research U n i t r e p o r t s , monthly, on p o s i t i o n s  the B r i t i s h Columbia h e a l t h c a r e i n d u s t r y t h a t have been vacant  t h i r t y days w i t h o u t Health  a s u i t a b l e replacement b e i n g r e c r u i t e d .  S e r v i c e s Research and Development 1980).  listed  as  " d i f f i c u l t - t o - f i l l " and  (Division  F i g u r e s f o r June  r e v e a l e d t h e r e were 193 p o s i t i o n s f o r nurses w i t h g e n e r a l  for of  1980  preparation  99 f o r n u r s e s w i t h s p e c i a l  (post-basic)  preparation. A s e r i e s of a r t i c l e s publicized (Bateson  the shortage  1980;  Fralic  i n the Vancouver Sun  and  of n u r s e s i n Vancouver and  1980).  The  Province  newspapers  throughout the  S e v e r a l h o s p i t a l s were r e p o r t e d  province  to have 20  or  more u n f i l l e d r e g i s t e r e d n u r s e p o s i t i o n s ; some p a t i e n t u n i t s were a l s o reported  to have been c l o s e d , at l e a s t  i n p a r t because of a shortage  nurses.  H o s p i t a l a d m i n i s t r a t o r s were quoted as s a y i n g t h a t even  r e c r u i t i n g e f f o r t s a c r o s s Canada had not  sufficed  to meet t h e i r  of  extensive present  * Marion Greenwood, Career C o u n s e l l o r , R e g i s t e r e d Nurses' A s s o c i a t i o n of B r i t i s h Columbia, 1980: p e r s o n a l communication. 1  2 requirements The  f o r nurses.  shortage of n u r s e s  i n B r i t i s h Columbia  n a t i o n a l shortage which has e x i s t e d War  II.  Initially  i t was  believed  but t h i s has n o t been the c a s e . s i s t e d and  intensified  The Canadian  i s r e p r e s e n t a t i v e of a  i n Canada s i n c e the b e g i n n i n g of World t h a t the shortage of n u r s e s was  The p r o f e s s i o n a l nurse  temporary,  shortage has  per-  i n the succeeding 40 y e a r s .  Nurses' A s s o c i a t i o n i n i t s submission t o the Royal  Commission on H e a l t h S e r v i c e s (1962, p. 62)  stated:  D e s p i t e a f a v o u r a b l e r a t i o of nurses t o p o p u l a t i o n i n comparison w i t h o t h e r c o u n t r i e s , t h e r e i s a shortage of n u r s i n g s e r v i c e s i n Canada b o t h i n q u a n t i t y and q u a l i t y . The p r e s e n t supply of n u r s e s i s n o t meeting the demand i n c e r t a i n areas of the c o u n t r y , nor i n some f i e l d s of n u r s i n g . The Royal Commission on H e a l t h S e r v i c e s (1962), concerned w i t h the p r o v i s i o n of h i g h q u a l i t y h e a l t h c a r e f o r a l l Canadians,  stated  in i t s  f i n a l r e p o r t t h a t the q u a l i t y of h e a l t h s e r v i c e s depended p r i m a r i l y on s u p p l y , a v a i l a b i l i t y , knowledge, s k i l l  and d e d i c a t i o n o f p r o f e s s i o n a l l y  q u a l i f i e d p e r s o n n e l , and i d e n t i f i e d an inadequacy p a r t i c u l a r l y n u r s e s , as one h e a l t h care In  of h e a l t h p e r s o n n e l ,  of the major problems c o n f r o n t i n g the  Canadian  system.  a study of n u r s i n g e d u c a t i o n i n Canada, Mussallem  observed  the  that,  "So  s e r i o u s i s the need f o r more n u r s e s  (1965, p . l )  ( i n 1965)  t h a t many  b e l i e v e i t can j e o p a r d i z e the e n t i r e s t r u c t u r e of m e d i c a l c a r e . " In  the e a r l y  1970's i t was  i n Canada had been overcome and,  t h o u g h t t h a t the problem  (DuGas 1971).  By 1973,  I t was  r a t i o of n u r s e s t o p o p u l a -  however, these p r o j e c t i o n s proved  i n a c c u r a t e , a t l e a s t f o r B r i t i s h Columbia reported.  shortages  i n f a c t , a s u r p l u s of n u r s e s was p r e d i c t e d  on the b a s i s o f f i g u r e s t h a t i n d i c a t e d a growing tion  of nurse  t o be  where severe s h o r t a g e s were  concluded a t t h a t time t h a t i n s p i t e of a f a v o u r a b l e nurse  3 to population r a t i o , the o v e r a l l supply of nurses in B r i t i s h Columbia was not s u f f i c i e n t to meet current requirements (Registered Nurses' Association of B r i t i s h 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 B r i t i s h Columbia was moving into a short supply period, despite a continuing r i s e i n the proportion of nurses to population. Several factors have contributed to the persistent shortage of r e g i s tered nurses i n Canada.  The introduction of medicare i n the 1960's  resulted i n increased u t i l i z a t i o n of health care f a c i l i t i e s .  This increased  u t i l i z a t i o n required more nurses to provide the care needed by patients. In addition, advances i n medical technology  used i n the treatment of  i l l n e s s have increased the need for highly s k i l l e d 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 S t a t i s t i c s Canada (1978, p. 19),  only 76.5 percent of nurses registered i n Canada i n 1976 were employed i n nursing.  The Registered Nurses' Association of B r i t i s h Columbia l i s t s  21,625 nurses registered i n 1980;  of this t o t a l , 5167,  or 23.9 percent were  not employed i n nursing (Division of Health Services Research and Development 1980, p.5-5).  This figure may be conservative as an indicator of  unused manpower p o t e n t i a l as i t does not include nurses who employed i n nursing and who  have not maintained  are not  nurse r e g i s t r a t i o n i n  B r i t i s h Columbia. A major concern of the investigator has been the supply of registered nurses i n B r i t i s h Columbia. for  There are several p o t e n t i a l sources  increased supply, including increased output from schools of nursing,  4 i n c r e a s e d immigration and  of n u r s e s  from other p r o v i n c e s and  other c o u n t r i e s  r e c r u i t m e n t of i n a c t i v e nurses back i n t o the work f o r c e . The  output of nurses  s i n c e World War requirements  from s c h o o l s of n u r s i n g has  increased  steadily  I I , b u t has not been adequate t o meet the i n c r e a s e d  f o r n u r s i n g s e r v i c e s ( R e g i s t e r e d Nurses' A s s o c i a t i o n of  B r i t i s h Columbia 1973).  Ten y e a r s ago,  i n B r i t i s h Columbia were educated  46 p e r c e n t o f new  nurse  registrants  i n B r i t i s h Columbia; i n 1980,  from n u r s i n g e d u c a t i o n programs i n B r i t i s h Columbia comprised  graduates  only  32  * p e r c e n t of new  registrants.  I n c r e a s i n g the numbers of s t u d e n t s  i n b a s i c n u r s i n g e d u c a t i o n programs would appear to be of  expanding the supply of n u r s e s  enrolled  an e f f e c t i v e method  i n B r i t i s h Columbia, b u t  t h e r e i s some  q u e s t i o n of the a c c e p t a b i l i t y of p r o p o s a l s t h a t would r e q u i r e i n c r e a s e d government e x p e n d i t u r e and  a t a time when the c o s t s of e d u c a t i o n are s o a r i n g  government i s committed to p o l i c i e s of r e s t r a i n t .  a v a i l a b i l i t y of a p p r o p r i a t e c l i n i c a l  facilities  In a d d i t i o n , the  and p r e p a r e d  teachers i s  by no means a s s u r e d . Historically, has been through and  the main source of n u r s e manpower i n B r i t i s h  immigration  of r e g i s t e r a b l e n u r s e s  With n u r s i n g shortages now  b e i n g r e p o r t e d w o r l d wide,  1975), i n s u f f i c i e n t numbers of nurses meet p r e s e n t requirements Another p o s s i b i l i t y  who  provinces  o t h e r c o u n t r i e s ( R e g i s t e r e d N u r s e s ' A s s o c i a t i o n of B r i t i s h  1973).  is  from other  in British  Columbia (Bergman  are a v a i l a b l e from these sources  largely  f o r i n c r e a s i n g the supply of r e g i s t e r e d  i n a c t i v e c o n s t i t u t e a source of supply  ignored, although  to  Columbia.  to r e c r u i t i n a c t i v e nurses back i n t o the n u r s i n g work f o r c e . are v o l u n t a r i l y  Columbia  nurses Nurses  t h a t has been  i t i s known t h a t nurses move i n and  out of  the  * of  M a r i l y n Carmack, E x e c u t i v e D i r e c t o r , R e g i s t e r e d Nurses A s s o c i a t i o n B r i t i s h Columbia, 1980: p e r s o n a l communication.  5 work f o r c e depending  upon f a m i l y r e s p o n s i b i l i t i e s  A s s o c i a t i o n of B r i t i s h Columbia in  1973).  I t has been observed t h a t ,  times of r e a l c r i s i s has t h e r e been genuine  i n a c t i v e n u r s e . " (Cooper 1967,  p.62).  ( R e g i s t e r e d Nurses'  interest  "Only  in activating  There has never been any  the  rational  p l a n n i n g f o r the o r d e r l y r e - e n t r y of i n a c t i v e nurses i n t o the n u r s i n g work f o r c e , y e t these n u r s e s r e p r e s e n t a s i g n i f i c a n t p o r t i o n of e x i s t i n g e d u c a t i o n a l l y prepared n u r s e s . A nurse who  has been i n a c t i v e f o r some time may  a c t i v e p r a c t i c e without p r e p a r a t i o n .  n o t want t o resume  Changes i n medicine and i n n u r s i n g  have made many of these n u r s e s p r o f e s s i o n a l l y o b s o l e t e .  It i s generally  accepted that p r e p a r a t i o n f o r p r o f e s s i o n a l r e - e n t r y i s best through an e f f e c t i v e r e f r e s h e r c o u r s e p l u s an adequate s p e c i f i c p o s i t i o n a nurse a c c e p t s . n u r s e s i n B r i t i s h Columbia who employment p l a n s , and  Very l i t t l e  accomplished  o r i e n t a t i o n t o the  i s known about  inactive  seek u p d a t i n g - t h e i r c h a r a c t e r i s t i c s ,  their  the e x t e n t t o which they r e p r e s e n t a v i a b l e source of  n u r s i n g manpower. In  early  1980,  a p p r o x i m a t e l y 450  names on the m a i l i n g l i s t the B r i t i s h Columbia  f o r the R e f r e s h e r Course  I n s t i t u t e of Technology,  accommodates 60 s t u d e n t s a y e a r . of  graduate n u r s e s had p l a c e d t h e i r Nurses  at  a course which p r e s e n t l y  An examination of the c h a r a c t e r i s t i c s  these n u r s e s , t o g e t h e r w i t h i n f o r m a t i o n about  p l a n s may  f o r Graduate  t h e i r f u t u r e employment  p r o v i d e i n f o r m a t i o n t h a t w i l l h e l p t o answer the q u e s t i o n : do  i n a c t i v e n u r s e s r e p r e s e n t a p o t e n t i a l source o f n u r s i n g manpower f o r the province?  6 Statement of the Purpose  ^  This study has two purposes ; f i r s t , to describe selected characteri s t i c s of nurses who  have expressed  interest i n a nursing refresher course  and,second, to determine the extent to which these nurses are a p o t e n t i a l 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 p r o f i l e of these nurses that describes selected personal and work-related  c h a r a c t e r i s t i c s , 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 r e s t r i c t i o n s on employability and preferences of p o s i t i o n as well as location.  4.  Describe the differences, i f any, between those nurses who return to work i n nursing and those who  plan to  plan to remain i n a c t i v e .  D e f i n i t i o n of Terms Inactive Nurse.  A graduate nurse who  Graduate Nurse.  An individual who  i s not employed i n nursing.  has s a t i s f a c t o r i l y completed  an educational program i n nursing. Registered Nurse.  A graduate nurse who  i s registered by the  Registered Nurses' Association of B r i t i s h Columbia.  7  Refresher Course for Graduate Nurses.  A course designed to prepare  an inactive nurse for active practice (Registered Nurses' Association of B r i t i s h Columbia 1980). / Characteristics. age,  Distinguishing features, such as marital status,  age of youngest c h i l d , nursing and other education, and work  experience. Employment Plans. ment as a  A description of intent to seek or not to seek employ-  registered nurse, including projected date of employment, p o s i t i o n  preferred and l o c a t i o n , and l i m i t a t i o n s on  employability.  Limitations The  study was  subject to the following l i m i t a t i o n s :  Limitations associated with the methodology. with no follow-up procedure, the researcher responses corresponded to the way  As with any  questionnaire  could not v e r i f y whether or not  i n 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. the conclusions  Generalizations  can only be made to a population  one used i n the study.  Therefore,  of any  of nurses similar to the  factors found to be predictors of an  intent to return to work i n nursing can be generalized only to nurses indicate interest in a refresher course and who characteristics.  of  who  have similar demographic  8 Organization of the Study Report This study report i s organized into five chapters. outlined the purpose of the proposed  study  the larger problem of nurse shortages. erature which considers  Chapter I has  and presented an overview of  Chapter I I presents a review of l i t -  the c h a r a c t e r i s t i c s of inactive nurses, employ-  ment patterns of women, factors thought to influence a nurse's decision to be employed i n nursing and, f i n a l l y , refresher courses f o r graduate nurses. Chapter I I I describes the research methodology used i n the study and includes development of the questionnaire, sample selection for data c o l l e c t i o n and data analysis.  and  procedures  The description of the sample,  the r e s u l t s of data analysis and discussion of the findings appear i n Chapter IV.  Summary and conclusions are presented i n Chapter V, together  with implications of the findings f o r nursing education and for nursing administration.  CHAPTER II REVIEW OF RELATED LITERATURE Introduction The t o a l nurse manpower supply for any given constituency can be viewed as being composed of three groups: active supply - those r e g i s t e r 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 i n nursing.  The persistent shortage of  nurses i n B r i t i s h Columbia has drawn attention to the potential c o n t r i bution of the t h i r d 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  i n a refresher course and sought to describe their c h a r a c t e r i s t i c s , their future employment plans i n nursing and to determine whether or not inactive nurses who manpower for B r i t i s h  seek updating represent a potential source of nursing Columbia.  Studies have not, u n t 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 B r i t i s h 9  Columbia  1973).  Murray (p. 94), for example, observes that despite evidence that  there were more than 13,000 registered nurses i n Ontario who were not working i n nursing, there had not been any studies designed to find out what i t would take to a t t r a c t them back to work or how many of them would be able to function adequately i f they did return.  This i n v e s t i -  gator i s not aware of any such published reports i n Canada. More attention has been focused on v o l u n t a r i l y inactive nurses i n the l i t e r a t u r e emanating from the United States.  There i s 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 i n the early 1960's, few e f f o r t s have been directed towards reducing a t t r i t i o n and/or a t t r a c t i n g inactive nurses back into the work force.  The reasons nurses withdraw from the work force are  widely held to be both economic and s o c i a l .  Low s a l a r i e s and family  r e s p o n s i b i l i t i e s are most often cited by nurses as reasons for i n a c t i v i t y (Anderson and Viko 1967; Marshall and Bruhn 1967; Platou and Peder son 1967; Reese et a l . 1962). (1961), Krueger (1971) and McCloskey  The r e s u l t s of studies by Corwin (1974) suggest that d i s s a t i s f a c t i o n  with the nurse's work i t s e l f i s a t h i r d variable that contributes to voluntary i n a c t i v i t y . The focus of the l i t e r a t u r e review which follows i s on studies that have investigated voluntary i n a c t i v i t y of graduate nurses.  A  search of nursing and related l i t e r a t u r e was conducted considering the c h a r a c t e r i s t i c s 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 i n nursing.  Studies  related to refresher courses for graduate nurses were also reviewed.  11 Characteristics of Inactive Nurses The c h a r a c t e r i s t i c s 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 i n 12 states to determine the c h a r a c t e r i s t i c s 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 r e g i s t e r ed and resident i n each state.  A p r o f i l e 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 f i v e 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.  S i x t y - f i v e percent of those planning  to return to work indicated they would l i k e a refresher course before they did so. Family r e s p o n s i b i l i t i e s were given as the major reason for voluntary i n a c t i v i t y 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 predicated to a major extent on the a v a i l a b i l i t y of suitable c h i l d care arrangements.  Nurses who  planned to remain inactive c i t e d 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 i n mental i n s t i t u t i o n s i n Kentucky  (Barker and Staton 1965)• As i n the previously c i t e d 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 w i t h a sample of 440  i n a c t i v e nurses  85 p e r c e n t response studies.  An  in Alberta.  i n a c t i v e nurse  of p r e - s c h o o l  i n A l b e r t a was  The  t o three c h i l d r e n at home, the youngest  (1967) r e p o r t e d on a two phase study  first  of whom  York  i n the community the  wanted t o r e t u r n t o work i n t o c o n t a c t w i t h  their  Data were c o l l e c t e d by means of a q u e s t i o n n a i r e  to 5200 i n a c t i v e n u r s e s .  c e n t ) expressed  under  i n one u p s t a t e New  involved surveying i n a c t i v e nurses  n u r s e s who  p r o s p e c t i v e employers. mailed  an  project  to f i n d out whether they wanted t o r e t u r n t o work i n n u r s i n g and second brought  on  previous  most l i k e l y m a r r i e d and  t o augment the supply of working n u r s e s  community.  f i n d i n g s , based  age.  Anderson and V i k o designed  unpublished  r a t e , were comparable t o those of the two  40 y e a r s of age w i t h one was  Her  an i n t e r e s t  Of the 3100  who  replied,  398  i n r e t u r n i n g t o work i n n u r s i n g .  (12.8  per-  Of t h a t  number, 78 p e r c e n t i n d i c a t e d they would p r e f e r p a r t - t i m e employment. Two  hundred and  s i x (52 p e r c e n t ) of the n u r s e s i n t e r e s t e d i n r e t u r n i n g  to work i n d i c a t e d a need f o r a r e f r e s h e r c o u r s e . P l a t o u and Pederson unemployed n u r s e s  (1967) conducted  i n one Minnesota  county  a survey of r e g i s t e r e d t o determine  a t t r a c t these n u r s e s t o the h o s p i t a l s e t t i n g . m a i l e d , 708  (69 p e r c e n t ) were completed  of the respondents  i n the p r e v i o u s s t u d i e s .  d i s c o v e r e d i n the c h a r a c t e r i s t i c s of n u r s e s who  and those who  did not.  characteristics  Little  differ-  wanted t o work  Three hundred and e i g h t e e n of the respondents  they would d e f i n i t e l y be were met.  The  questionnaires  (age, m a r i t a l s t a t u s and number of c h i l d r e n ) were  s i m i l a r to those of respondents ence was  what a c t i o n s might  Of the 1026  and r e t u r n e d .  but  said  i n t e r e s t e d i n employment i f c e r t a i n c o n d i t i o n s  The m a j o r i t y s t a t e d they would p r e f e r p a r t - t i m e employment.  13 F l e x i b l e hours and scheduling and competent c h i l d 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 employment on the part of their husbands. Personal f u l f i l l m e n t was reported as the prime motivating factor for the greatest number of respondents.  It was concluded that the r e c r u i t -  ing p o t e n t i a l for inactive nurses i n this study was limited to part-time positions. Marshall and Bruhn (1967) examined the c h a r a c t e r i s t i c s that d i s t i n g u i s h inactive nurses who enrolled i n a refresher course and returned to active nursing practice from other inactive nurses. Questionnaires were mailed to a study group of 92 registered nurses had completed  who  a refresher course and were known to have returned to active  p r a c t i c e ; they were also mailed to a comparison  group of 265 systematically  random sampled nurses who were registered but not employed i n nursing. The response rate for the study group and the comparison  group were  72 and 49 percent respectively. The r e s u l t s 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 d i s t i n g u i s h the two groups.  Nurses  i n 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 p r i o r to the study as compared to 12 for the comparison  group.  S i m i l a r l y , nurses i n the study  group had been inactive for seven years i n contrast to one year for those  14 i n the comparison  group.  The major reasons given by the nurses i n Marshall and Bruhn's (1967) study group for being currently employed i n nursing were f i n a n c i a l need, a desire to keep informed and interest i n nursing.  For those who were  inactive, the main reasons given for their i n a c t i v i t y were family r e s p o n s i b i l i t i e s , disillusionment with the profession, inadequate s a l a r i e s and unsuitable hours.  Findings suggested that a number of  inactive nurses returned to active practice when there was  financial  need and/or family r e s p o n s i b i l i t i e s had lessened. The findings of this study are at variance with those reported e a r l i e r by Reese, Siegal and Testoff (1964).  In the l a t t e r 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 i n nursing after a period of i n a c t i v i t y were older and had been inactive longer than those who chose not to return to work. A longitudinal study i n i t i a t e d i n 1962  (Knopf 1975; Knopf 1979) i s  the only known attempt to follow a cohort of nurses from the time they entered a nursing education program through their working l i v e s . Preliminary r e s u l t s confirmed that work status i s c l o s e l y 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 P a t t e r n s of Women 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 appears f u n c t i o n o f the presence  or absence o f a b a l a n c e between a c t i v e n u r s i n g  supply and nurse requirements, b u t a l s o of changing towards women and work.  49 p e r c e n t  societal  attitudes  D u r i n g the p e r i o d s i n c e World' War I I , the number  of n u r s e s remaining v o l u n t a r i l y from  t o be n o t o n l y a  i n a c t i v e i n the U n i t e d S t a t e s has dropped  i n 1951 t o 30 p e r c e n t i n 1972 (Levine 1978).  r e s e a r c h i n t h i s a r e a i s l a c k i n g , i t has been suggested a r e r e t u r n i n g t o a c t i v e p r a c t i c e today,  Although  t h a t more n u r s e s  i n p a r t because of p e r s i s t e n t  s h o r t a g e s , b u t a l s o because s o c i e t a l t r e n d s have made i t much more a c c e p t a b l e f o r women t o combine marriage predominantly  a female  and a c a r e e r .  o c c u p a t i o n - over  are women ( S t a t i s t i c s Canada 1978,  Since n u r s i n g i s  98 p e r c e n t o f n u r s e s  i n Canada  p. 37) - changes i n the p a t t e r n s o f  women's l i v e s over the p a s t 30 y e a r s have had a d i r e c t e f f e c t upon n u r s e s and n u r s i n g . The  l a b o u r f o r c e p a r t i c i p a t i o n r a t e f o r m a r r i e d women i n Canada has  i n c r e a s e d markedly over the p a s t 20 y e a r s .  In 1977,  44.1 p e r c e n t of a l l  m a r r i e d women i n the p o p u l a t i o n were i n the l a b o u r f o r c e , compared w i t h 26.8  percent  i n 1966 and 19.2 p e r c e n t i n 1960 (Women's Bureau 1978;  Women's Bureau 1975).  There i s evidence o f an emerging p a t t e r n wherein  a woman l e a v e s the l a b o u r f o r c e upon the b i r t h of h e r f i r s t r e - e n t e r s l a t e r when f a m i l y r e s p o n s i b i l i t i e s a r e l e s s e n e d .  c h i l d and The  h i g h e s t labour f o r c e p a r t i c i p a t i o n f o r m a r r i e d women o c c u r s i n the 20 t o 24 y e a r age group; the r a t e drops  o f f i n the two subsequent age i n t e r v a l s ,  then r i s e s a g a i n a f t e r age 35 (Women's Bureau 1978). Employment p a t t e r n s o f n u r s e s do n o t appear t o d i f f e r g r e a t l y  from  employment p a t t e r n s o f women i n the g e n e r a l p o p u l a t i o n , a t l e a s t up t o  16 the age of 35. When Altman compared the labour force p a r t i c i p a t i o n rates of nurses with those of female high school graduates, female college graduates and t o t a l women by age groups, comparisons revealed the same b i modal pattern for a l l groups which was high p a r t i c i p a t i o n following graduation from school, a f a l l i n g off i n the rate during the c h i l d bearing ages and a second r i s e a f t e r 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 i n and out of the work force.  Nursing neither l o s t as many active participants during their late twenties and early t h i r t i e s 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 i n the United States could account f o r 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 f i v e predominantly  female occupations and found that compared to other groups of professional women, nurses are generally less active i n their profession.  Estimates  varied from a high of 55 percent for nurses to 48 percent for s o c i a l workers, 37 percent for l i b r a r i a n s and 38 percent for elementary teachers. While he suggests the c o n f l i c t between work and family tQ be p a r t i c u l a r l y acute for nurses, actually there are a number of factors that apparently influence a nurse's decision to be employed i n nursing.  .  17  F a c t o r s A f f e c t i n g Employment of Nurses S t u d i e s of labour f o r c e p a r t i c i p a t i o n r a t e s of m a r r i e d female have shown t h a t the primary determinants husband's income  and  of employment are wage r a t e s ,  the presence of s m a l l c h i l d r e n .  example, e s t i m a t e d t h i s r e l a t i o n s h i p and confirmed s a l a r y had  negative.  the presence  t h a t the  nurse's effects  of p r e - s c h o o l c h i l d r e n were b o t h  Bognano, Hixon and J e f f e r s  married nurses concluded  Benham (1971), f o r  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 r a t e , w h i l e the  of husband's income and  nurses  (1974) e s t i m a t e d the response  t o a change i n wage r a t e s and husband's e a r n i n g s  t h a t the w i f e works t o supplement f a m i l y income.  of  and  In o t h e r words,  as the husband's income r i s e s , the m a r r i e d n u r s e s ' p r o p e n s i t y t o work falls. and  L i n k and  Settle  (1980) i n v e s t i g a t e d the e f f e c t of h i g h e r wages  o t h e r employment inducements on the supply of n u r s i n g s e r v i c e s and  found  t h a t h i g h e r wages would have the p a r a d o x i c a l e f f e c t of r e d u c i n g the  number of hours worked by m a r r i e d  nurses.  C l e l a n d , e t a l . (1970) i n v e s t i g a t e d f a c t o r s i n f l u e n c i n g 479 n u r s e s t o r e a c t i v a t e t h e i r c a r e e r s and  found  married  t h a t 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 b e s t p r e d i c t o r s of which women would choose t o be a c t i v e l y employed.  In a d d i t i o n , 41 p e r c e n t of the  e n t s viewed time c o n f l i c t s between employment and home as the n e g a t i v e consequences of  respond-  primary  working.  Inducements o f f e r e d by n u r s i n g 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 n u r s e ' s v a l u e s and the terms of a l t e r n a t i v e s open to her) to motivate her t o make the c o n t r i b u t i o n s demanded i f she i s t o r e a c t i v a t e her c a r e e r ( C l e l a n d e t a l . 1970, p. 451). Cleland  suggests  t h a t the employment of m a r r i e d n u r s e s can be c h a r a c t e r -  i z e d 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: r a p i d  turnover  and change of work s t a t u s when f a m i l y needs and f a m i l y 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 e x i s t i n g 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 f i n a n c i a l exigencies versus those who a c t i v e l y seek long-term professional careers. age of youngest  When the  c h i l d and f i n a n c i a l need were held constant, the factors  of career d e s i r a b i l i t y , professional behaviour and economic value of work had the greatest c o r r e l a t i o n with employment a c t i v i t y . Studies by Altman (1971) and Hover (1976) suggest that the a t t r i t i o n rate from nursing i s higher for nurses who have a baccalaureate degree i n nursing.  Hover (1976) found that nurses with baccalaureate degrees were  more l i k e l y to seek promotions outside the hospital system, most often i n education or research.  Altman (1971) determined  that the a t 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 i n nursing and consequently with baccalaureate degrees and thus  nurses  more f l e x i b i l i t y with regard to  employment w i l l be more l i k e l y 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 f i v e years a f t e r graduation, 30 percent of diploma nurses and 3A percent of baccalaureate nurses were not working i n nursing.  The number  of nurses with a baccalaureate degree who were employed i n non-nursing positions increased from one percent f i v e years after graduation to s i x percent 10 years a f t e r graduation. Previous research has made i t clear that labour force p a r t i c i p a t i o n  19 of n u r s e s cannot be understood except i n the c o n t e x t o f m a r i t a l and age of c h i l d r e n .  Cleland  (1970, p.450) suggests  status  that:  For the m a r r i e d female n u r s e , whose marriage i s v i a b l e , d e c i s i o n s p e r t a i n i n g t o employment a r e based upon h e r p e r c e p t i o n of what i s b e s t f o r the f a m i l y . P o s i t i v e f i n a n c i a l consequences  of work and o p p o r t u n i t y t o a c h i e v e c a r e e r  g o a l s must be p e r c e i v e d as g r e a t e r than the n e g a t i v e consequences  i f the  m a r r i e d woman i s t o become and remain employed i n n u r s i n g . N e a r l y every study d e a l i n g w i t h i n a c t i v e nurses p o i n t s out the importance  of f a m i l y r e s p o n s i b i l i t i e s as a d e t e r r e n t t o r e t u r n i n g t o work  in nursing.  The most common r e q u e s t s of n u r s e s surveyed are f o r more  flexibility  of hours and f o r c h i l d c a r e s e r v i c e s .  A l s o of g r e a t import-  ance t o i n a c t i v e n u r s e s i s the a v a i l a b i l i t y of r e f r e s h e r c o u r s e s .  R e f r e s h e r Courses f o r Graduate S e v e r a l a u t h o r s have i n v e s t i g a t e d  Nurses  the e f f e c t i v e n e s s of r e f r e s h e r  programs i n f a c i l i t a t i n g a r e t u r n to a c t i v e s t a t u s .  Reese, e t a l . (1962)  commented on the employment s t a t u s o f 353 n u r s e s who  completed  a refresher  course.  About 77 p e r c e n t of the n u r s e s were employed s i n c e t a k i n g the  course.  I f i t i s assumed t h a t those n u r s e s a t t e n d i n g a r e f r e s h e r c o u r s e  have some p r e d i s p o s i t i o n f o r a r e t u r n t o a c t i v e s t a t u s , then t h i s i s not s u r p r i s i n g . who  completed  Mayberry  (1967) found t h a t 65 p e r c e n t of 680  a r e f r e s h e r program r e t u r n e d t o work i n n u r s i n g .  the reasons g i v e n by n u r s e s f o r c o n t i n u e d or resumed i n a c t i v i t y b e i n g unable c h i l d care  nurses Some of included  t o n e g o t i a t e s u i t a b l e hours of work or t o make a c c e p t a b l e arrangements.  Anderson n u r s e s who  result  had  (1968) r e p o r t s the r e s u l t s of a study of 108 taken a r e f r e s h e r c o u r s e and  confirms  inactive  t h a t the number and  20 age d i s t r i b u t i o n of children i n the family had the most influence on the number of hours and the time of day that the nurse was w i l l i n g to work.  Summary A review of l i t e r a t u r e concerned with the problem of voluntary i n a c t i v i t y among graduate nurses suggests that attempting to increase the unbroken tenure of nurses i s probably f u t i l e since variables such as marriage and children a f f e c t tenure so strongly.  It seems clear that  many nurses w i l l have an interrupted career i n nursing. clear i s whether this interruption i s planned adjunct  or simply happens as an  to the nurses' l i v e s as wives and mothers.  suggests i t i s the l a t t e r .  The nurse who  did not plan to return to nursing.  She  What i s not  Cooper (1967)  l e f t practice 15 or 20 years ago  i s now  returning, often from  economic necessity, but also as a r e s u l t of lessening family responsib i l i t i e s and/or a wider acceptance of the working woman/mother,  from a  desire for personal f u l f i l l m e n t and from an awareness of the need for her services.  Since she did not plan to return to practice, she made no  e f f o r t to keep p r o f e s s i o n a l l y 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 i n nursing i s thought to be influenced by two sets of variables; those related to the individual (personal variables) (work-related  variables).  and those related to the work setting  Work-related variables include hours of work,  available c h i l d care f a c i l i t i e s , salary and job s a t i s f a c t i o n . An inactive nurse i s l i k e l y to be married and under 40 years of age with pre-school aged children.  F l e x i b l e hours and suitable c h i l d care  21 arrangements are the major c o n d i t i o n s resumes a c t i v e s t a t u s .  Family r e s p o n s i b i l i t i e s ,  p r o f e s s i o n a l d i s i l l u s i o n m e n t are remain i n a c t i v e . provide  before  a nurse  s a l a r i e s and i n a c t i v e nurses  a desire for personal  fulfillment  f o r i n a c t i v e n u r s e s to resume employment i n n u r s i n g .  s t u d i e s reviewed were concerned s p e c i f i c a l l y w i t h d e s c r i b -  i n g 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 n u r s e s who a c t i v e s t a t u s but r e q u i r e d extent  low  the main reasons why  F i n a n c i a l need and  the m o t i v a t i o n  None of the  t h a t have t o be met  were ready to resume  a r e f r e s h e r course b e f o r e  d o i n g so.  The  t o which r e f r e s h e r c o u r s e c a n d i d a t e s are s i m i l a r to or d i f f e r e n t  from other The  i n a c t i v e n u r s e s has n o t been documented.  s t u d i e s reviewed p r o v i d e  support f o r the p r o p o s i t i o n t h a t some  d i n a c t i v e nurses plan and  to r e t u r n to employment i n n u r s i n g  r e q u i r e a r e f r e s h e r course b e f o r e  c h a r a c t e r i s t i c s of i n a c t i v e n u r s e s who plans  d o i n g so.  The  i n the  future  numbers and  the  a c t u a l l y f o l l o w through w i t h  to r e t u r n to work i n n u r s i n g cannot be  stated with  confidence.  In a r a p i d l y changing s o c i e t y , i t i s of i n t e r e s t t h a t most of s t u d i e s p e r t a i n i n g to i n a c t i v e n u r s e s were c a r r i e d out more than y e a r s ago. not  As  a consequence many of the f i n d i n g s may  d i r e c t l y a p p l i c a b l e to the p r e s e n t  however, d i d p r o v i d e f o r the p r e s e n t  situation.  outdated  Earlier  important background i n f o r m a t i o n  study.  be  and  their  the  10 and  studies, gave d i r e c t i o n  CHAPTER I I I METHODOLOGY Introduction This study was exploratory i n 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 c h a r a c t e r i s t i c s of inactive nurses who had expressed interest i n a refresher course and to determine whether an expressed interest i n a refresher course was a predictor of intent to return to work i n nursing. Hungler  Survey methodology, defined by P o l i t and  (1978, p.206) as, "...that branch of research that examines the  c h a r a c t e r i s t i c s , behaviours, attitudes and intentions of a group of people by asking individuals belonging to that group ( t y p i c a l l y only a subset) to answer a series of questions," was considered most appropriate to achieve the stated research purpose. The l i t e r a t u r e reviewed indicated that an inactive nurse's decision to work or not work i n nursing was l i k e l y a function of two sets of f a c t o r s : those related to the i n d i v i d u a l , such as marriage .and c h i l d r e n , 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 c o l l e c t data on selected personal and work-related variables and was mailed to a convenience sample of inactive nurses who had expressed interest i n a refresher course. 22  23 Selection of the Sample Convenience  sampling was used i n this study.  It i s known that i n  today's technological society, re-entry into a profession such as nursing requires updating of knowledge and s k i l l , course.  t y p i c a l l y through a refresher  For this reason i t was assumed that nurses who were interested i n  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 i n s t i t u t i o n that offered refresher courses on a regular basis to contact nurses on their refresher course mailing l i s t f o r 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 i n nursing were drawn from the l i t e r a t u r e and incorporated into a 12 page questionnaire (see Appendix B). Questions were designed to c o l l e c t 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 c h i l d and annual family income.  These factors were selected because i t has  been suggested they influence a nurse's decision to be employed i n nursing. Education data.  Since nursing education has two d i s t i n c t paths,  24 diploma and baccalaureate, i t was considered appropriate to request information about type of basic nursing education i n order to group respondents on this variable when examining  future employment plans.  Other  data i n this section - post-basic nursing education and education i n other than nursing - were s o l i c i t e d 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 p r i o r to becoming inactive and the number of years they had been i n a c t i v e . work experience of respondents  Of interest as well was the  i n health-related and non-health-related  fields. Employment data.  The focus of this study was the determination of the  future employment plans of refresher course candidates.  Accordingly,  questions were formulated to c o l l e c t data on selected work-related variables: plans for future employment as a registered nurse, p o s i t i o n desired, date available f o r employment, full-time or part-time and other r e s t r i c t i o n s on employment.  Questions were also designed that e l i c i t e d  respondents'  reasons f o r taking a refresher course and the advantages and disadvantages they perceived i n working as a registered nurse.  A summary of personal and  work-related variables used i n this study i s presented i n 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 f a m i l i a r with the substantive content.  The panel  included s i x nurses who were enrolled i n the Master of Science i n Nursing  WORK RELATED  PERSONAL  Registration Practicing Non-practicing Resigned Never Registered  Marital Status Single Married Other Age Under 25 25 - 29 30 - 34 35 - 39 40 - 44  25  45 50 55 60  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 r e s t r i c t e d 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 r e s t r i c t e d .  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  Work experience Registered Nurse Health Related Other Volunteer  Education Basic Nursing Education Diploma Degree Post-basic Nursing Education Other post-secondary  education  Date l a s t employed Full-time Part-time  Advantages and Disadvantages to working as a Registered Nurse  Number of years employed as a r e g i s tered nurse Full-time Part-time C l 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 U n i v e r s i t y of B r i t i s h Columbia and School  of Nursing  ness and  faculty.  Comments were sought c o n c e r n i n g  adequacy of the c o n t e n t .  reviewed by technical  a coder and  a programmer/analyst to d e t e c t and  f o r a r e f r e s h e r c o u r s e and  of the main study. adequacy and  The  t e s t e d by  going  i t can  inadequacies  t o the expense of a f u l l  30 n u r s e s  who  items. "...  part  the  clarity,  While a p r e -  provide  an  opportu-  or unforseen problems  scale study."  (Polit  and  Hugler  from the p r e t e s t were used t o make s e v e r a l e d i t o r i a l - t y p e  changes i n the q u e s t i o n n a i r e  and  one  major r e v i s i o n .  respondents were asked i n an open-ended q u e s t i o n taking a r e f r e s h e r course.  increase  To f a c i l i t a t e  the r e l i a b i l i t y of the instrument,  technique  a refresher course." i n t o 24 c a t e g o r i e s and counted.  The  reasons  a n a l y s i s and  to  a f i x e d - a l t e r n a t i v e question A list  content  u n i t of a n a l y s i s was  of  11  analysis  "reason f o r t a k i n g  E i g h t y - s i x responses from the p r e t e s t were s o r t e d then the number of u n i t s i n each c a t e g o r y  was  Only c a t e g o r i e s c o n t a i n i n g a t l e a s t t h r e e u n i t s were r e t a i n e d .  r e s u l t i n g e l e v e n c a t e g o r i e s were then v a l i d a t e d by  colleagues  three  statistical  developed u s i n g a m o d i f i e d  ( K e r l i n g e r 1973).  In the p r e t e s t ,  to l i s t  developed from the responses g i v e n on the p r e t e s t .  a l t e r n a t e responses was  The  on  p.347). Results  was  advise  to h e l p assess  freedom from b i a s of the q u e s t i o n n a i r e  n i t y f o r d e t e c t i n g at l e a s t gross  for  was  t h e r e f o r e would n o t be  purpose of the t e s t was  t e s t cannot guarantee a p e r f e c t instrument,  1978,  appropriate-  difficulties.  been accepted  before  the  the  In a d d i t i o n , the q u e s t i o n n a i r e  A r e v i s e d v e r s i o n of the q u e s t i o n n a i r e was had  f o u r members of  and  incorporated  i n t o the r e v i s e d  two  questionnaire.  nursing  27 Final  Questionnaire The  f i n a l questionnaire, modified  on the b a s i s of p r e t e s t i n g , c o n s i s t e d  of 25 q u e s t i o n s r e l a t e d t o the study p r o j e c t and o f the f i x e d response  type.  Response a l t e r n a t i v e s were v a r i e d , i n c l u d i n g dichotomous items, m u l t i p l e c h o i c e items, f u n n e l and rank order q u e s t i o n s .  A s e t o f 14 q u e s t i o n s  (Items 19 through 32) r e q u e s t i n g i n f o r m a t i o n about respondents' a part-time  interest i n  r e f r e s h e r course was i n c l u d e d i n the q u e s t i o n n a i r e a t the  r e q u e s t o f the s p o n s o r i n g  agency but was n o t c o n s i d e r e d p a r t of the study  p r o j e c t and w i l l n o t be r e p o r t e d on h e r e .  Reliability  and V a l i d i t y o f the Instrument  A c t i o n s c a r r i e d out t o enhance the c l a r i t y o f the r e s e a r c h i n c l u d e d a c r i t i c a l r e v i e w by a p a n e l o f e x p e r t s and a p r e t e s t .  instrument In  a d d i t i o n , s i n c e a l l o f the items were o f the f i x e d response type, the p o t e n t i a l f o r u n i f o r m i t y o f s t i m u l u s and thus g r e a t e r r e l i a b i l i t y achieved  was  ( K e r l i n g e r 1973).  A p a n e l o f nurse e x p e r t s was used t o h e l p e s t a b l i s h c o n t e n t  validity.  A d m i n i s t r a t i o n o f the Q u e s t i o n n a i r e On February  13, 1980, q u e s t i o n n a i r e s were m a i l e d  nurses whose names were on the R e f r e s h e r February  1, 1980.  s t a t i n g the n a t u r e  t o 413 graduate  Course m a i l i n g l i s t  as of  Accompanying t h e q u e s t i o n n a i r e was a c o v e r i n g o f the study, g i v i n g g e n e r a l d i r e c t i o n s ,  letter  outlining  p a r t i c i p a n t r i g h t s and r e q u e s t i n g the c o o p e r a t i o n of the respondents (see Appendix C ) .  A stamped, s e l f - a d d r e s s e d envelope and p o s t c a r d were i n c l u d e d  i n the q u e s t i o n n a i r e p a c k e t .  Respondents were asked t o i n d i c a t e on the  p o s t c a r d whether or n o t they wished t h e i r name t o c o n t i n u e  on the r e f r e s h e r  28  course m a i l i n g l i s t naire.  and t o s i g n and r e t u r n i t s e p a r a t e l y from the q u e s t i o n -  The main purpose of the p o s t c a r d was t o p e r m i t  a t i o n t o update t h e i r m a i l i n g l i s t second m a i l i n g t o only  the course  administr-  b u t i t was a l s o used to f a c i l i t a t e a  those respondents who had n o t r e t u r n e d  the p o s t c a r d .  Response Rate A f o u r week p e r i o d was allowed During  f o r r e t u r n of the q u e s t i o n n a i r e s .  t h i s p e r i o d , 140 completed q u e s t i o n n a i r e s were r e t u r n e d and t h r e e  q u e s t i o n n a i r e s were r e t u r n e d 34.1 p e r c e n t .  as n o n - d e l i v e r a b l e .  The response r a t e was  As respondents remained anonymous, a d e c i s i o n was made t o  attempt t o improve the response r a t e by sending Appendix D) t o n u r s e s who had n o t r e t u r n e d those who had n o t r e t u r n e d  follow-up  l e t t e r s (see  the p o s t c a r d , assuming t h a t  the p o s t c a r d had a l s o n o t r e t u r n e d the  questionnaire. A t o t a l o f 199 v a l i d q u e s t i o n n a i r e s out o f a p o s s i b l e 410 was r e c e i v e d by the d e a d l i n e The if  s e t f o r i n i t i a t i o n of data a n a l y s i s (Table 1 ) .  f i n a l response r a t e was 49 p e r c e n t . i t contained  at least  the i n f o r m a t i o n on p r e s e n t  n u r s i n g and f u t u r e p l a n s f o r employment. the n a t u r e  A q u e s t i o n n a i r e was deemed  of the non-respondents  valid  employment s t a t u s i n  No attempt was made t o a s s e s s  n o r 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 • Study P o p u l a t i o n  Number  n u f f l D e i ;  Percent  _ , Respondents  199  48.6  Non-Respondents  211  51.4  Total  " 0  L  v  y  100.0  29 Of the 280 indicated  respondents  they would l i k e  mailing l i s t .  who  r e t u r n e d the p o s t c a r d , 68  to have t h e i r name removed from the  course  As the q u e s t i o n n a i r e s were r e t u r n e d anonymously, i t was  not p o s s i b l e to assume t h a t those who from  (24 p e r c e n t )  the m a i l i n g l i s t  r e q u e s t e d t h a t t h e i r names be removed  d i d not complete the q u e s t i o n n a i r e .  Data A n a l y s i s The d a t a were a n a l y z e d u s i n g the S t a t i s t i c a l S o c i a l Sciences  (Nie, e t a l . 1975).  ence between i n a c t i v e nurses who and  those who  To determine  planned  Package f o r the i f there was  a  differ-  to r e t u r n t o work i n n u r s i n g  d i d n o t , i n a c t i v e respondents  were a s s i g n e d t o one  of  sub-groups: n u r s e s p l a n n i n g t o r e t u r n t o work as r e g i s t e r e d n u r s e s nurses p l a n n i n g to remain i n a c t i v e . group and  and  f o r each  a c h i - s q u a r e s t a t i s t i c a p p l i e d to s e l e c t e d v a r i a b l e s : m a r i t a l  s t a t u s , age,  age  since completion in nursing. criterion  F r e q u e n c i e s were c a l c u l a t e d  two  of youngest  child,  annual  f a m i l y income, number of y e a r s  of b a s i c n u r s i n g e d u c a t i o n and number of y e a r s  A l l s t a t i s t i c a l a n a l y s e s were t e s t e d a g a i n s t an  of p<.05 and  are r e p o r t e d i n Chapter  IV.  inactive  alpha  CHAPTER IV FINDINGS AND  DISCUSSION  Introduction Data from 199 q u e s t i o n n a i r e s were t a b u l a t e d under t h r e e c a t e g o r i e s : respondents who were employed as r e g i s t e r e d n u r s e s  (N=46), respond-  ents who were i n a c t i v e i n n u r s i n g b u t who planned to resume a c t i v e as r e g i s t e r e d n u r s e s upon c o m p l e t i o n o f a r e f r e s h e r c o u r s e (N=101) respondents who were i n a c t i v e i n n u r s i n g and planned t o remain a f t e r c o m p l e t i n g a r e f r e s h e r course (N=52).  status and  inactive  T a b l e 2 shows the d i s t r i -  b u t i o n o f respondents a c c o r d i n g to employment s t a t u s i n n u r s i n g .  TABLE 2 NUMBER AND PERCENTAGE DISTRIBUTION OF RESPONDENTS ACCORDING TO EMPLOYMENT STATUS IN NURSING  (N=199)  EMPLOYMENT STATUS  Number  Percent  Employed as R e g i s t e r e d Nurse  46  23.1  153  76.9  Not Employed as R e g i s t e r e d Nurse P l a n to resume employment as R.N. Do n o t p l a n to resume employment as R.N.  199  Total  30  101  66.0  52  34.0  100.0  31 The r e s u l t s of d a t a a n a l y s i s a r e p r e s e n t e d  in five sections.  S e c t i o n A p r e s e n t s the demographic, e d u c a t i o n and work e x p e r i e n c e c h a r a c t e r i s t i c of the respondents. g i v e n by respondents  S e c t i o n B d e s c r i b e s the  reasons  f o r taking a nursing r e f r e s h e r course.  Section C  d e s c r i b e s the employment p o t e n t i a l of the sample of i n a c t i v e and i n c l u d e s p e r c e i v e d advantages and d i s a d v a n t a g e s  t o working as a  r e g i s t e r e d n u r s e , f u t u r e employment p l a n s i n n u r s i n g and on e m p l o y a b i l i t y .  In S e c t i o n D n u r s e s who  n u r s i n g are compared w i t h those who section who  to  restrictions  p l a n t o r e t u r n t o work i n  p l a n t o remain i n a c t i v e .  (E) c o n t a i n s a b r i e f d e s c r i p t i o n of the respondents  were a l r e a d y employed as r e g i s t e r e d Space was  fifth study  nurses.  w r i t e a d d i t i o n a l comments i f they d e s i r e d .  respondents  Sixty-one nurses  t h i s o p p o r t u n i t y to express a wide range of concerns  as a r e g i s t e r e d nurse  The i n the  p r o v i d e d a t the end of the q u e s t i o n n a i r e f o r  n u r s i n g , about t h e i r own  nurses  i n c l i n a t i o n and a b i l i t y  and  took  o p i n i o n s about  t o resume employment  and about the r e f r e s h e r course i t s e l f .  These are  summarized and p r e s e n t e d , w i t h examples, i n Appendix E.  A.  Demographic, E d u c a t i o n and Work E x p e r i e n c e C h a r a c t e r i s t i c s o f 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 n u r s e s ing  accord-  t o demographic, e d u c a t i o n and work e x p e r i e n c e v a r i a b l e s i s  p r e s e n t e d i n T a b l e s 3 t o 7. c h i l d and annual The sample was  M a r i t a l s t a t u s , age,  f a m i l y income of respondents  composed e n t i r e l y o f women.  (83.7 p e r c e n t ) and  over 40 y e a r s of age  to  child,  age  of youngest  14.5  age  of  youngest  are p r e s e n t e d  i n Table  A m a j o r i t y were m a r r i e d  (54.2 p e r c e n t ) .  With r e s p e c t  p e r c e n t of the 138 respondents  who  3.  32 TABLE 3  NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSES ACCORDING TO MARITAL STATUS, AGE, AGE OF YOUNGEST CHILD AND INCOME (N=153)  CHARACTERISTICS  Percent  Number  Marital Status 5.9 83.7 10.4  Single Married Other  9 128 16  Total  153  100.0  4 22 44 38 25 12 8  2.6 14.4 28.8 24.8 16.3 7.8 5.3  153  100.0  20 43 42 15 18  14.5 31.1 30.4 10.9 13.1  138  100.0  10 28 49 61  6.8 18.9 33.1 41.2  148  100.0  ,  Age 25-29 years 30-34 years 35-39 years 40-44 years 45-49 years 50-54 years 55 years and over Total Age of Youngest Child Under 5 years 5-9 years 10-14 years 15-17 years 18 years and over Total Annual Family Income Less than $10,000 $10,000 - $19,000 $20,000 - $29,000 $30,000 and over Total  33 completed age  t h i s s e c t i o n r e p o r t e d t h e i r youngest c h i l d t o be o f p r e - s c h o o l  (under f i v e y e a r s ) .  The m a j o r i t y (72.4 p e r c e n t ) o f the respondents  had c h i l d r e n o f s c h o o l - a g e .  The f i n d i n g s f o r the two v a r i a b l e s , age  and  age o f youngest c h i l d , a r e i n c o n s i s t e n t w i t h those r e p o r t e d i n e a r l i e r s t u d i e s of i n a c t i v e n u r s e s (Barker and S t a t o n 1965; S i e g a l and T e s t o f f 1964)  Buchan 1967;  Reese,  where a m a j o r i t y o f the i n a c t i v e n u r s e s  who  p a r t i c i p a t e d i n the s t u d i e s were under the age of 40 and had p r e - s c h o o l age c h i l d r e n (1967) who  b u t a r e c o n s i s t e n t w i t h the f i n d i n g s o f M a r s h a l l and Bruhn  suggested t h a t the i n a c t i v e nurse who  r e t u r n s to a c t i v e  p r a c t i c e a f t e r c o m p l e t i n g a r e f r e s h e r c o u r s e i s o l d e r than the p o p u l a t i o n of i n a c t i v e n u r s e s and has reduced f a m i l y  responsibilities.  An annual f a m i l y income of $20,000 or more was p e r c e n t o f the respondents and f o r 41.2 $30,000.  Ten  p e r c e n t i t was  74.3  more than  (6.8 p e r c e n t ) o f the respondents r e p o r t e d an annual f a m i l y  income o f under $10,000. may  r e p o r t e d by  The number o f r e l a t i v e l y h i g h incomes r e p o r t e d  be r e f l e c t i v e of f a m i l i e s where t h e r e a r e two wage e a r n e r s . R e g i s t r a t i o n s t a t u s of respondents i s shown i n T a b l e 4.  One  hundred and s i x (69.3 p e r c e n t ) o f the respondents r e p o r t e d they were not r e g i s t e r e d as a n u r s e i n B r i t i s h Columbia.  Of t h i s number, however, 51  (48.1 p e r c e n t ) r e p o r t e d they had r e s i g n e d i n good s t a n d i n g which means t h a t they can become r e g i s t e r e d a g a i n by p a y i n g the c u r r e n t fee.  The t o t a l number o f r e s p o n d e n t s , then, who  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  were e i t h e r  registration registered  percent).  The c o m p o s i t i o n o f the sample o f i n a c t i v e nurses a c c o r d i n g to h i g h e s t e d u c a t i o n i n n u r s i n g and a c c o r d i n g to the date b a s i c n u r s i n g e d u c a t i o n was was  completed  i s r e p o r t e d i n T a b l e 5.  the h i g h e s t e d u c a t i o n a l q u a l i f i c a t i o n f o r 124  A diploma i n n u r s i n g (81.0 p e r c e n t ) o f the  34  TABLE 4 NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS ACCORDING TO REGISTRATION STATUS  REGISTRATION STATUS  Registered  in British  Not R e g i s t e r e d  Number  Columbia  in British  Columbia  Resigned i n good s t a n d i n g Never r e g i s t e r e d Total  (N=153)  Percent  47  30.7  106  69.3  i n B.C.  i n B.C. 153  51  48.1  55  51.9 100.0  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 i n Nursing Basic Diploma  124  81.0  24  15.7  5  3.3  153  100.0  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  153  100.0  Post-Basic Diploma/Certificate Baccalaureate Degree Total  Date Basic Nursing Education Completed  Total  Mean number of years since basic nursing education completed: 19.5 Range: 36 years  36 inactive nurses i n 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 e a r l i e r  studies, respondents i n t h i s study had completed their basic nursing education e a r l i e r than other inactive nurses. Table 6 shows the number of years of f u l l - t i m e employment as a registered nurse as reported by the sample of inactive nurses.  A  majority had been employed i n a full-time capacity for three years or less (54.9 percent), and of this number, f i v e respondents indicated they had never been employed f u l l - t i m e as a registered nurse.  The mean  number of years since l a s t f u l l - t i m e employment as a registered nurse (for nurses who reported previous f u l l - t i m e 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 i n this study were employed other than as a registered nurse at the time they completed the questionnaire. Thirty-two (17.6 percent) were employed i n health-related occupations and 19 (12.5 percent) i n other occupations.  The reasons why nurses i n  the study sample were employed i n other than nursing were not r e a d i l y apparent, but for some i t may have been because they were unable to be employed i n nursing without f i r s t updating their knowledge and Twenty-eight  skills.  (54.9 percent) of the respondents who were employed other  than as a registered nurse indicated they would have preferred employment as a registered nurse but were r e s t r i c t e d because of a lack of opportunity to update themselves i n 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 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 R e s p o n s e  2  1.3  153  100.0  None  Total  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  148  100.0  Total  Mean number of years since l a s t employed f u l l - t i m e 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  102  69.9  Employed i n Health Related Occupation  32  17.6  Employed i n Non-Health Related Occupation  19  12.5  153  100.0  Not Employed  Total  39 B.  Reasons f o r Taking a Refresher Course  The assumption that inactive nurses take a refresher course primarily to become employed i n nursing i s not supported by the data obtained i n 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 i n 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 f o r taking a refresher course, 21 (14.1 percent) indicated i t would be to "obtain B r i t i s h Columbia r e g i s t r a t i o n " and 18 (12.1 percent) would take a refresher course primarily to "become employable i n nursing."  Only 12 (8.1 percent) of the respondents  indicated that the most important reason f o r taking a refresher course would be to "become employed i n 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 i n nursing" (23 percent).  The reasons why respondents apparently viewed the process of updating as being more important than the outcome, employment i n nursing, are  not clear.  The p o s s i b i l i t y that respondents f e l t some o b l i g a t i o n to  rank the reason that most c l o s e l y resembled the refresher course purpose above their actual reason f o r taking a refresher course i s acknowledged. If the reason given as being most important was biased i n favour of the stated refresher course purpose, then the second most important reason given may  i n f a c t be a more v a l i d representation of the nurse's r e a l  reason f o r taking a refresher course. 51 respondents who  To test t h i s , the responses of  selected "update" as their f i r s t reason f o r taking a  40 r e f r e s h e r course were a n a l y z e d  t o determine t h e i r  t h i r d most important  When the f i r s t reason was s e t a s i d e ,  reasons.  employment i n n u r s i n g s t i l l important  reason  r e c e i v e d a low p r i o r i t y .  f o r t a k i n g a r e f r e s h e r course  e n t s would be " t o g a i n c o n f i d e n c e as a n u r s e " third,  s t a t e d second and  The second most  f o r t h i s group of respond(29.1 p e r c e n t ) , and the  " t o become employable i n n u r s i n g " (26.5 p e r c e n t ) .  The reasons  tend t o c o n f i r m the assumption t h a t some i n a c t i v e n u r s e s view themselves as h a v i n g outdated knowledge and s k i l l s as a consequence o f p r o l o n g e d inactivity  i n nursing.  Most Important Reason  (N=149)  Update n u r s i n g knowledge and s k i l l s  34.2%  O b t a i n B r i t i s h Columbia R e g i s t r a t i o n  14.1%  Become employable i n n u r s i n g  12.1% 8.1*  Become employed i n n u r s i n g Second Most Important Reason  (N=141)  Update n u r s i n g knowledge and s k i l l s  17.7%  Gain c o n f i d e n c e as a nurse  14.4%  Personal  13.5%  satisfaction  12.1%  Become employable i n n u r s i n g T h i r d Most Important Reason (N=139) Become employable i n n u r s i n g  23%  Update n u r s i n g knowledge and s k i l l s  16.6%  Personal  13.7%  satisfaction  P r o v i d e f o r s t a b l e and secure f u t u r e  12.3%  FIGURE 2 REASONS GIVEN BY INACTIVE NURSE RESPONDENTS FOR TAKING A REFRESHER COURSE  (N=153)  41 C.  Future Employment i n Nursing  In l i g h t of the acute nursing shortages extant i n B r i t i s h  Columbia  at the time this study was i n i t i a t e d , the future employment plans of inactive nurses i n the study sample were of p a r t i c u l a r i n t e r e s t .  The  numbers of budgeted but u n f i l l e d positions on the one hand and the large numbers of nurses interested i n refresher courses on the other, had resulted i n considerable pressure being exerted on educators to increase the numbers of seats i n existing courses and to create new refresher courses i n d i f f e r e n t regions of the province (Registered Nurses' Association of B r i t i s h Columbia May, 1980).  I f significant  numbers of inactive nurses i n the study sample could be shown to be planning to resume active status i n nursing upon completion of a refresher course, there would be some j u s t 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 i n Table 8.  A majority (66 percent) of the respondents  indicated they planned to resume active status i n nursing. percent) would prefer part-time employment.  Most (57.4  Additional data were sought  i n order to provide more s p e c i f i c 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 i n nursing; location; c l i n i c a l preference; and r e s t r i c t i o n s on employability.  Results are reported i n Tables 9 to 13.  42 TABLE 8 NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS ACCORDING TO FUTURE EMPLOYMENT PLANS IN NURSING (N=15 3)  FUTURE EMPLOYMENT IN NURSING  Number  Plan to be Employed as Registered Nurse  101  Percent  66.0  Full-time  42  41.6  Part-time  58  57.4  1  1.0  No Response Do Not Plan to be Employed as Registered Nurse Total  52  34.0  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 i n each category.  The most frequently used categories  w i l l be discussed. Time c o n f l i c t s with family a c 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 professiona l advancement was assigned a r e l a t i v e l y low p r i o r i t y .  Only s i x  (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  Nursing Factors  106  Percent  69.3  P r o f e 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  13  8.5  I n t e r a c t i o n with health personnel  0  0.0  P r o f e s s i o n a l advancement  6  3.9  to others  Financial Security  28  18.4  Mental S t i m u l a t i o n  11  7.2  S o c i a l Contacts  1  0.6  Other  1  0.6  No Response  6  3.9  153  100.0  Total  44  TABLE  NUMBER  AND P E R C E N T A G E  PERCEIVED  DISTRIBUTION  DISADVANTAGES  10  OF INACTIVE  O F WORKING  AS  NURSE  RESPONDENTS  A REGISTERED  PERCEIVED DISADVANTAGES OF WORKING AS R.N.  Time Competition - less time f o r :  42.5  65 56  36.6  3  2.0  6  3.9  20.9  32  Too much r e s p o n s i b i l i t y / n o t enough time and authority Inadequate nursing knowledge Tasks unrelated to nursing care Unsatisfactory standards of patient care D i s s a t i s f a c t i o n with Employment Conditions  (N=153)  Percent  Number  Immediate family Household a c t i v i t i e s Social, community and personal activities Frustrations Associated with Nursing  NURSE  SHOWING  12  7.9  11  7.2  1  0.6  8  5.2  29.5  45  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  3  2.0  11  7.2  31  20.3  0  0.0  Health Problems  1  0.6  Other  2  1.3  No Response  8  5.2  153  100.0  Total  45 w i l l most often pursue work goals which focus upon maintenance of e x i s t i n g s k i l l s rather than advancement or growth (Cleland, et a l . 1970, p.451). Respondents expressed considerable d i s s a t i s f a c t i o n with employment conditions, p a r t i c u l a r l y hours of work and rotating s h i f t s .  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 i n this study must be o f f s e t by p o s i t i v e rewards i f a married nurse i s to resume active status, but evidence of this i s lacking i n the data provided.  On balance i t would appear that  the disadvantages outweigh the advantages.  Apart from the advantages  pertaining d i r e c t l y to nursing (nursing f a c t o r s ) , the remaining p o s i t i v e rewards of employment could conceivably be achieved i n other work r  settings.  In the absence of evidence of a strong professional commitment,  i t i s suggested that f o r nurses i n this study, the goal of employment i n nursing may be secondary to the goal of employment i n any job that provides an opportunity f o r personal f u l f i l l m e n t 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 f o r such a low response rate may be associated with.the admission procedures of the s p e c i f i c refresher course i n which the respondents were interested.  Prospective candidates are given written notice of a new  course and applications are then accepted on a first-come, f i r s t - s e r v e d  46 basis.  Courses tend to f i l l very quickly and many respondents  f r u s t r a t i o n with a system that r e l i e s e n t i r e l y on a telephone  expressed call.  Obviously the date refresher course candidates return to work i n nursing i s highly dependent upon the date they are accepted i n a refresher course and neither can be predicted with any degree of certainty.  Location The d i s t r i b u t i o n of the 101 respondents who  indicated that they  planned to return to work as registered nurses according to the geographic area i n which they wished to be employed i s presented i n Table 11. As might be expected, a majority (74.3 percent) would seek employment as registered nurses within the area served by the educational i n s t i t u t i o n from which the sample was obtained.  This i s also the area where more  than 70 percent of the vacant positions f o r nurses with general preparation were known to e x i s t (Division of Health Services Research Development 1980).  and  Further analysis of the data, however, shows that  the actual manpower p o t e n t i a l f o r the area i s limited to nurses would prefer part-time employment.  Of the 75 respondents who  who  indicated  they would seek employment i n the metropolitan area served by the educational i n s t i t u t i o n 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 i n 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 i s acknowledged that the s i t u a t i o n with regard to vacant positions i n nursing i s not s t a t i c , but changes from month to month, the findings of this study do point to the need f o r 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-TOFILL POSITIONS.  REGIONAL HOSPITAL DISTRICT  Greater Vancouver  Percentage D i s t r i b u t i o n of Difficult-to-fill positions*  74.1  Capital Fraser Valley  1.2  Okanagan  Number of Respondents  Percent  75  74.3  8  7.9  5  4.9  4  4.0  South-East  3.5  0  0.0  Island - Coast  2.4  0  0.0  Central  1.2  1  1.0  16.5  2  2.0  o -  0.0  6  5.9  101  100.0  North-Central North  1.2  No Response Total  *  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 i n 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 d i s t r i b u t i o n of the respondents i n the study who plan to be employed as registered nurses, according to type of health care agency i n 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 i n a general h o s p i t a l .  A majority (81.2 percent)  indicated they would prefer employment i n a general h o s p i t a l .  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 i n specialty areas such as p e d i a t r i c s and o b s t e t r i c s , areas f o r which the refresher course does not adequately prepare them. These findings may  r e f l e c t a lack of s u f f i c i e n t information about  refresher courses, but also provide evidence of a very r e a l problem f o r returning nurses.  I t seems reasonable to assume that a nurse who  has  worked i n a specialty area p r i o r to becoming inactive would want to return to a work s i t u a t i o n that i s f a m i l i a r and, i n many cases, f o r which the nurse has s p e c i a l preparation, yet the only option open to these nurses i s a course that prepares them to function i n adult medical, s u r g i c a l and extended care settings. where a nurse may  The s i t u a t i o n could well a r i s e  e n r o l l i n a refresher course but be d i s s a t i s f i e d 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  General Hospital  82  Percent of Total Respondents  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 O f f i c e  9  8.9  15  14.8  Other  Note:  Numbers do not sum to 101 as several respondents indicated  more than one preference.  50 R e s t r i c t i o n on Employability Respondents who  stated they planned to resume employment i n  nursing also indicated that they would require a number of conditions to be met i f they did so.  The r e s u l t s are summarized i n Table 13.  Aside from a preference f o r part-time employment discussed e a r l i e r , the r e s t r i c t i o n that occurred most frequently was with respect to length of shift.  Thirty-seven (36.6 percent) of the respondents stated they  would expect to work eight hour s h i f t s only.  Perhaps because 12 hour  s h i f t s are a f a i r l y recent innovation, this finding was not reported i n the e a r l i e r studies.  Married nurses with children may f e e l 12 hours i s  too long to be away from their f a m i l i e s .  For those who would require  c h i l d care, they may also have found that few, i f any, c h i l d care centers accommodate children f o r an extended Other r e s t r i c t i o n s mentioned  day.  are consistent with those that would  be expected from women with another primary r o l e .  Employment as a  registered nurse would be subject to suitable c h i l d 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 l i m i t their employment to day s h i f t only (20.8 percent), further reduces the manpower p o t e n t i a l of this group of nurses.  Alternate Plans The 53 respondents who  stated that they did not plan to work i n  nursing upon completion of a refresher course continue to view employment i n nursing as an option f o r the future. of respondents are shown i n Table 14.  The future plans f o r t h i s group Sixteen (28.3 percent) of the  respondents indicated they would become employed i n nursing only i f i t became a " f i n a n c i a l 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 Respondents  Eight hour s h i f t only  37  36.6  Subject to arranging suitable c h i l d care  30  29.7  During school year only  22  21.8  Day s h i f t only  21  20.8  Days/evenings only  21  20.8  Week-days only  14  13.9  Subject to a v a i l a b i l i t y 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 s h i f t s only  3  3.0  Nights only  3  3.0  Evenings only  2  2.0  1  1.0  Evenings/nights No  only  restrictions  5  Other  Note:  14  13.9 5.0  Numbers do not sum to 101 as some respondents indicated more than one r e s t r i c t i o n  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  Employment at some future date Employment i f f i n a n c i a l necessity  Number  Percent  15  28.8  15  Continue education  28.8  13  25.0  Other  9  17.4  Total  52  100.0  employed as a registered nurse at some unspecified time " i n the future". Thirteen (24.5 percent) stated they would "continue their upon completion of the refresher course.  education"  Continuing education  i n this  instance was thought to mean either i n a post-basic specialty i f a v a i l able, or i n a baccalaureate  program.  Both usually require recent  c l i n i c a l nursing experience as a prerequisite f o r admission, a requirement that could conceivably be met through a refresher course.  53 D.  Comparison of Subsamples  One objective of t h i s study was to describe the differences, i f any, between those nurses in the sample who planned to return to work i n nursing and those who planned to remain inactive.  Two  subsamples  of respondents were i d e n t i f i e d for this step of the data a n a l y s i s : 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 i n nursing i s 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  c h i l d 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 c r i t e r i o n of  p<.05. The r e s u l t s of data analyses f a i l e d to identify any factors which distinguished respondents i n the study who plan to resume active status in nursing upon completion of a refresher course from those who  planned  to remain i n a c t i v e .  E.  Employed Nurses  The assumption that nurses who express an interest in a refresher course are by d e f i n i t i o n not active i n nursing i s refuted by the r e s u l t s obtained i n this study.  While i t was not a purpose of this project to  report on the c h a r a c t e r i s t i c s and employment plans of respondents were employed as registered nurses at the time they completed the  who  54 questionnaire, the f a c t that 46 (23.1 percent) of the respondents were employed as registered nurses warrants a b r i e f comment. From data collected i n this study, there i s no way the reasons why  to determine  employed nurses would take a refresher course.  One  p o s s i b i l i t y i s that as nursing roles become increasingly s p e c i a l i z e d , mobility within the profession becomes increasingly r e s t r i c t e d . who want to change jobs may  Nurses  f i n d they lack the knowledge and s k i l l s  necessary to function i n 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 i s the appropriate means f o r 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 f i r s t 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 i n nursing but who planned to resume active status upon completion of a refresher course (N=101); and respondents who were inactive i n 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 c h i l d  would be of school age and annual family .income would be over $20,000. She would be registered or 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.  A basic diploma i n nursing would be her highest  educational q u a l i f i c a t i o n .  She would have graduated from a basic  nursing education program more than 10 years ago and have been employed f u l l - t i m e i n nursing f o r three or less years. Reasons f o r taking a refresher course.  The primary reason f o r  taking a refresher course would be to update nursing knowledge and s k i l l s . To a lesser extent, respondents i n the study indicated they would take a refresher course i n order to obtain B r i t i s h Columbia r e g i s t r a t i o n and to become "employable" i n nursing. Future employment.  Professional maintenance would be the most  important advantage to working as a registered nurse f o r the majority of respondents i n this study.  Time scheduling c o n f l i c t s 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 d i r e c t l y 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 i n a general hospital within the metropolitan area served by the educational i n s t i t u t i o n from which the study sample was obtained.  Employment would also be conditional upon the a v a i l a b i l i t y  of eight hour (as opposed to 12 hour) s h i f t s and suitable child-care facilities.  To a lesser extent, employment as a registered nurse would  be r e s t r i c t e d to day s h i f t s and week-days during the school year. Predictors of employment.  Analysis of the data supplied by the  respondents i n this study who were inactive i n nursing f a i l e d to i d e n t i f y any factors which distinguished nurses who planned to resume active status i n nursing from those who planned to remain i n a c t i v e .  Application  of the chi-square s t a t i s t i c to contingency table data f o r the variables marital status, age, age of youngest c h i l d and annual family income did not reveal a s i g n i f i c a n t difference i n d i s t r i b u t i o n 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 i n 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 e a r l i e r studies with respect to the c h a r a c t e r i s t i c s of inactive nurses suggests that inactive nurses who express i n t e r e s t i n a refresher course are older, have older children and completed their basic nursing education e a r l i e r than the population of inactive nurses. 2.  The extent to which inactive nurses i n the study sample  represent a potential source of nurse manpower i s limited by a preference for part-time employment and conditional upon suitable hours and the a v a i l a b i l i t y 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 r e s u l t s indicate that a s i g n i f i c a n t number of inactive nurses would resume employment as registered nurses i f certain conditions could be met.  These findings have implications f o r nursing education and for  nursing administration.  Implications f o r Nursing Education The factor of occupational obsolescence as a consequence of i n a c t i v i t y i n nursing was a major concern of respondents i n 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 f o r graduate nurses i n B r i t i s h Columbia have, for the most part, been designed to a l l e v i a t e c r i t i c a l shortages of registered nurses, when and where the shortages occur.  Few systematic  e f f o r t s have been made to orient the inactive nurse to modern nursing practice.  Cooper's observation ( i n 1971)  that, "For the most part,  organized nursing has not been cognizant of the great interest of many inactive nurses i n their profession" (Cooper 1971, p.27), appears to be as v a l i d 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 i s desirable whereby nurses can continue to r e l a t e to their profession during periods of i n a c t i v i t y . As long as nursing i s a predominantly i t s members w i l l have interrupted careers.  female profession, many of For the nurse who l e f t  nursing more than 10 years ago, c e r t a i n l y a ref resher course i s desirable. The inactive nurse i n the f i r s t few years of i n a c t i v i t y , however, does not need "refreshing" but she does need continuing education i f she i s to remain professionally current.  Present programs i n continuing  education f o r nurses tend to be designed f o r currently employed nurses. Nursing education has been slow to recognize the need to provide opportunities f o r nurses to continue their education during periods of inactivity.  There are a v a r i e t y of ways i n which such continuing  education programs could be implemented, including the use of programmed learning materials and/or the use of i n t e r r a c t i v e t e l e v i s i o n . 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 importance i n maintaining competence.  Short-term preceptorships with a desig-  nated resource person could be made available i n a v a r i e t y of health care  60 agencies, thus providing an opportunity for the inactive nurse to integrate knowledge with practice i n 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 l i f e l o n g learning f o r professional p r a c t i c e .  Career planning i s an important aspect of pro-  f e s s i o n a l commitment and includes planning for i n a c t i v i t y as well as for professional advancement.  Implications f o r Nursing Administration The r e s u l t s of this study also have implications f o r 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 i n a refresher course.  T r a d i t i o n a l l y nursing has depended upon single or  married women without children to meet s t a f f i n g requirements.  Women with  children have tended to withdraw from the nursing work force, i n 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 c o n f l i c t with family a c t i vities.  Many of these nurses are now expressing a desire to resume  practice as registered nurses but f i n d f u l l - t i m e practice and rotating s h i f t s incompatible with family l i f e . Findings of this study suggest that inactive nurses with family r e s p o n s i b i l t i e s are motivated to contribute to nursing, but their c o n t r i bution i s subject to certain conditions, at least f o r the period they have committed to r a i s i n g a family. For nursing administration to deny  61 these individuals access to the nursing work force because of a set of r i g i d expectations regarding a v a i l a b i l i t y , 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 f o r voluntary i n a c t i v i t y  and to  l i m i t access to a large pool of educated, experienced nurses. Another important consideration i s that while the majority of nurses i n this study indicated they would prefer part-time employment at the moment, the p o s s i b i l i t y that as family r e s p o n s i b i l i t i e s lessen, employment may be extended  to f u l l - t i m e i n the future further strengthens  the case f o r 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 r o l e , and i n the long term, help to ensure a supply of experienced, f u l l - t i m e nurses f o r the future.  Recommendations f o r Further Study On the basis of the findings and implications of this study, i t i s 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 i n the nursing work force. 2.  A longitudinal study be i n i t i a t e d i n B r i 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 l i f e t i m e 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 n u r s e s who  i n t e r e s t i n a r e f r e s h e r course  t o determine t h e i r c o n t i n u i n g  express  education  needs and the most a p p r o p r i a t e means by which these needs c o u l d be 4.  E f f o r t s be d i r e c t e d t o p l a n n i n g e d u c a t i o n a l programs t h a t a r e  s p e c i f i c a l l y designed  to meet the c o n t i n u i n g e d u c a t i o n needs of n u r s e s  during periods of voluntary 5.  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Planning f o r nursing needs and resources. Bethesda Md: U.S. Department of Health, Education and Welfare. F r a l i c , Shelley. 1980. Lack of glamour one of reasons f o r chronic nurse shortage. Vancouver Sun. Vancouver: 24 July. Hover, J u l i e . 1975. Diploma vs degree nurses: are they alike? Nursing Outlook 23:11:684-87. Imai, H. Rose. 1970. The employment picture f o r nurses i n Canada. Ottawa: Canadian Nurses' Association. James, V a l e r i e . 18:4:333-39.  197 9.  Nursing shortage h i t s hard.  Nursing Forum  65 K a l i s h , B e a t r i c e . , and K a l i s h , P h i l i p . 1979. American J o u r n a l of N u r s i n g 79:3:470-78.  N u r s i n g shortage?  Yes!  Keaveny, Timothy J . , and Hayden, Robert L. 1978. Manpower p l a n n i n g f o r nurse p e r s o n n e l . American J o u r n a l of P u b l i c H e a l t h 68-7:656-61. Kerlinger, Fred. 1973. Foundations of b e h a v i o r a l r e s e a r c h . 2nd Toronto: H o l t , R i n e h a r t and Winston I n c .  ed.  Kermacks, C l a i r e . 1979. N u r s i n g e d u c a t i o n study r e p o r t . 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 E d u c a t i o n , S c i e n c e and Technology. Knopf, L u c i l l e . degree n u r s e s  1979. Nurse c a r e e r p a t t e r n study: b a c c a l a u r e a t e ten y e a r s a f t e r g r a d u a t i o n . H o s p i t a l T o p i c s 57:5:5-9.  Knopf, L u c i l l e . 1975. R.N.'s: one and f i v e y e a r s a f t e r New York: N a t i o n a l League f o r N u r s i n g . Kramer, Marlene. S t . L o u i s : C.V.  1974. Mosby  R e a l i t y Shock: why Co.  graduation.  nurses l e a v e n u r s i n g .  Krueger, J a n e l l e C. 1971. The e d u c a t i o n and u t i l i z a t i o n of n u r s e s . A pardox. N u r s i n g Outlook 19:10:676-79. L a V i o l e t t e , Suzanne. 1979. Nurse i n c e n t i v e s s t a y d e s p i t e s p o t t y r e s u l t s . Modern H e a l t h c a r e 9:11:69-70. L e v i n e , Eugene. 1978. N u r s i n g supply and r e q u i r e m e n t s : the c u r r e n t s i t u a t i o n and f u t u r e p r o s p e c t s . In P o l i t i c a l , S o c i a l and e d u c a t i o n a l f o r c e s on n u r s i n g : impact of p o l i t i c a l f o r c e s . New York: N a t i o n a l League f o r N u r s i n g . L i n k , C h a r l e s , 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 i n c e n t i v e and l a b o r s u p p l y of m a r r i e d p r o f e s s i o n a l n u r s e s : an economic a n a l y s i s . N u r s i n g Research 29:4:238-43. M a r s h a l l , Melody J . , and Bruhn, John G. 1967. R e f r e s h e r courses r e a c t i v a t i o n of n u r s e s . N u r s i n g Outlook 15:1:59-61.  and  Mayberry, Minerva A. 1967. Are nurse r e f r e s h e r programs worthwhile? H o s p i t a l s , J o u r n a l of American H o s p i t a l A s s o c i a t i o n 41:June 1:95-100. Moore, Joan F. 1979. N u r s i n g s h o r t a g e : a q u e s t i o n of numbers o r of management? H o 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 h e a l t h s e r v i c e s : n u r s i n g e d u c a t i o n i n Canada. Ottawa: Queen's P r i n t e r . N i e , Norman H.; H a l l , H a d l a i C.; J e n k i n s , Jean G.; S t e i n b r e n n e r , K a r i n , and Bent, D a l e 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 f o r wording structured questionnaires. Public Opinion Quarterly 34:191-201. Platou, C a r l M., and Pederson, Dennis W. 1967. Can more part-time nurses be recruited. Hospitals, Journal of the American Hospital Aassociation 41:Mayl6:72-82. P o l i t , Denise F., and Hungler, Bernadette P. 1978. Nursing research: p r i n c i p l e s 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. many caps went on again? Nursing Outlook 10:8:517-19.  1962. How  Registered Nurses' Association of B r i t i s h Columbia. 1980. Annual Report. Vancouver: Registered Nurses' Association of B.C. Registered Nurses' Association of B r i t i s h Columbia. 1980. Qualifying, refresher courses approval process explained. RNABC News 12:3:3. Registered Nurses' Association of B r i t i s h Columbia. 1973. Registered nurse manpower i n B r i t i s h Columbia. Vancouver: Registered Nurses' Association of B.C. Royal Commission on Health Services V o l . I I . Printer.  1965. Ottawa: Queen's  Saskatchewan Department of Health. 1975. F i n a l report of nursing supply conference. Research and Planning Branch. Saskatchewan Department of Health. Stambler, Howard V. 1979. Health manpower f o r the nation - a look ahead at the supply and the requirements. Public Health Reports 94:1:3-10. S t a t i s t i c s Canada. 1978. Nursing i n Canada: Canadian nursing s t a t i s t i c s , 1977. Ottawa: Minister of Industry, Trade and Commerce. Swanberg, G l o r i a , and Knutson, C h r i s t i n a . 1979. Increasing nurse demand highlights need f o r long-range r e c r u i t i n g plans. Modern Healthcare 9:11:68-70. Treece, Eleanor Walters. 1977. Elements of research i n nursing. 2nd ed. St. Louis: C.V. Mosby Co. Wandelt, Mabel A.; Pierce, P a t r i c i a 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. F a c t s and f i g u r e s about women In the l a b o u r force. Ottawa: Woman's Bureau, Canada Department o f L a b o u r , Queen' Printer. Woman's Bureau. Queen's  1964.  Women a t work i n Canada: Department o f Labour  Printer.  Woman's B u r e a u . 1978. Women i n the l a b o u r f o r c e : f a c t s and f i g u r e s . P a r t 1: l a b o u r f o r c e a c t i v i t y . Ottawa: M i n i s t e r of Supply and S e r v i c e s , Queen's P r i n t e r . Woolley, Alma. 2661-63.  1966.  I n a c t i v i t i s . American Journal of Nursing66:12:  APPENDIX A LETTER OF AGREEMENT  APPENDIX B  REFRESHER COURSE  QUESTIONNAIRE  DIRECTIONS 1.  Please read each question and i t s instructions carefully.  2.  I f you f e e l that a question i s d i f f i c u l t for you to answer, please check the response which i s closest to that which you feel i s correct, or use the response "other" where i t i s provided and specify your reason for doing so.  3.  Please do not sign the questionnaire. Anonymity i s 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 i s your age?  3.  4.  Single  J  Married  |  | Under 25  ]  |  45-49  [  f 25 - 29  |  |  50 - 54  [  | 30 - 34  1  t  55-59  |  | 35 - 39  |  [ 60 - 64  |  [ 40 - 44  Other  Age of youngest child ( i f applicable) |  | Under 5 years  |  | 5-9  |  | 10 - 14 years  years  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  15 - 17 years |  | 18 years and over  72  SECTION I i 5.  L i s t b a s i c and p o s t - b a s i c n u r s i n g e d u c a t i o n , where taken ( c o l l e g e , t e c h n i c a l s c h o o l , 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 a s i c n u r s i n g education f i r s t . Diploma Certificate or Degree  Example :Bo&-ic J diploma. - R . N . Poit BoA-ic 7 Diploma. 2 Degree - B . S . N . Basic  1  Post-Basic  1  Specialty ( i f applicable)  Type o f Institution  n/a. O.K. NuAAing n/a  Hospital TexihnicAl School  Date Completed 7959 796S 1970  2 3  6.  L i s t academic p r e p a r a t i o n beyond h i g h s c h o o l i n f i e l d s other than n u r s i n g ( 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 o n l y courses o r programs o f s i x months d u r a t i o n o r l o n g e r . Subject or Specialty  Diploma Certificate or Degree  Type o f Institution  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 s t a t u s ? R e g i s t e r e d i n B r i t i s h Columbia?  1  | No  I f yes,  |  |. P r a c t i s i n g  |  [ Non-practising  I f no,  |  | Resigned i n good s t a n d i n g i n B.C.?  |  1 Never r e g i s t e r e d l n B.C.  |  |  Yes  Are you R e g i s t e r e d i n another P r o v i n c e o r Country? | I  | No  |  j  Yes  | Other ( s p e c i f y )  8. A r e you c u 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 r e q u i r e d to complete a Refresher Course 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?  10.  I  I  No  Yes  Are you p r e s e n t l y employed as a R e g i s t e r e d Nurse? Full-time (35 hrs/week or more)  |  | Part-time ( l e s s than 35 hrs./week)  I  | Casual  |  | Not employed as an R.N.  I f employed as a R e g i s t e r e d Nurse, s t a t e j o b t i t l e : I f not employed as a R e g i s t e r e d Nurse, check one o f the f o l l o w i n g : I am c u r r e n t l y unemployed and not seeking employment as an R.N. ~| I am c u r r e n t l y unemployed and seeking employment as an R.N. ~| I am c u 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 l a c k of o p p o r t u n i t y to update m y s e l f . "| I am c u r r e n t l y employed other than as an R.N., employment as an R.N.  and not s e e k i n g  "| I am c u r r e n t l y employed other than as an R.N., but would p r e f e r employment as an R.N. J  11.  i a c u r r e n t l y employed other than as an R.N., would p r e f e r employment as an R.N. but am r e s t r i c t e d because of a l a c k of o p p o r t u n i t y to update m y s e l f .  Have you been employed i n a n u r s i n g or h e a l t h r e l a t e d p o s i t i o n i n a c a p a c i t y other than as a R e g i s t e r e d Nurse s i n c e completing your b a s i c n u r s i n g education? For example, as a graduate, ( n o n - r e g i s t e r e d ) n u r s e , o r p r a c t i c a l  L  No  J  Y e s  I f y e s , p l e a s e describe-below, l i s t i n g most recent employment Job T i t l e 1 J.. o / . o  J. U.  No. of y r s in position  Fulltime  Parttime  Casual  Date of leaving  first.  Reason for leaving  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 s i n c e completing your b a s i c n u r s i n g e d u c a t i o n .  Job T i t l e  No o f y r s i n job  Fulltime  Parttime  Date of leaving  Casual  Reason for leaving  1. 2. J. 4.  13.  Have you worked as a v o l u n t e e r s i n c e completing your b a s i c n u r s i n g education?  \Z3  N°  EU  Yes  I f y e s , i n what c a p a c i t y and f o r how long? No. of years  Name of Agency or T i t l e  Date of Leaving  |  None |  | Less than 1 year  |  [ 1-3  years  |  [ 4-7  years  | 8-11  years  12 - 15 years j  | more than 15 years  Date l a s t employed f u l l - t i m e as an R.H.  8-11  None |  | Less than 1 year  |  | 1-3  years  Reason f o r leaving  ] |  years  "1 12 - 15 y e a r s |"more than 15 years  | | 4 - 7 years Date l a s t employed p a r t - t i m e 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  Hospital  ]  Convalescent/Rehab H o s p i t a l  j  Educational  ]  Extended Care H o s p i t a l  ]  General H o s p i t a l  J  Health Unit - Home Care only  ]  Health Unit - Public Program  j Mental Health/Community Care Team Nursing Home/Community Care F a c i l i t y  Facility Physician's  Office  Psychiatric/Mental  Hospital  P r i v a t e Duty  I  17.  Research  Health  Industry Other ( s p e c i f y )  | V.O.N.  I f you answered General H o s p i t a l i n Question 16, please s p e c i f y c l i n i c a l area(s). Medical Unit  Newborn Nursery  Surgical Unit  Operating Room  Pediatrics  Recovery Room  Obstetrics  Out-Patient/Ambulatory Care  Psychiatry  Rehabilitation  C e n t r a l Supply  Renal D i a l y s i s  Emergency | I.V.  Therapy  Medical/Surgical Care  Intensive  | Other ( s p e c i f y )  76  SECTION IV 18.  Which THREE o f the f o l l o w i n g reasons f o r t a k i n g most important t o you? P l e a s e rank the reasons to you, p l a c i n g a "1" beside the most important second most important reason, and a "3" beside reason. I f fewer than t h r e e , please rank those  the Refresher Course are i n order o f importance reason, a "2" beside the the t h i r d most important that are important t o you.  want to be employed i n n u r s i n g to become employable i n n u r s i n g a change from present a c t i v i t i e s continue my education i n n u r s i n g to g a i n confidence as a nurse d e s i r e f o r new l e a r n i n g experiences to o b t a i n B r i t i s h Columbia R e g i s t r a t i o n for personal s a t i s f a c t i o n to p r o v i d e f o r a s t a b l e and secure f u t u r e to earn a l i v i n g to update n u r s i n g knowledge and  skills  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&onmation. 19.  Which type o f r e f r e s h e r course would BEST meet your s p e c i f i c needs a t t h i s time? |  | The F u l l - t i m e ten week course, daytime hours on weekdays  |  | P a r t - t i m e course given over a longer p e r i o d o f time w i t h evening and weekend c l a s s e s .  as g i v e n a t present  1$ juUl-timZ, proceed to q u e s t i o n number 26.  T{ patit-timz, answer questions 20 t o 25; BEFORE proceeding t o q u e s t i o n 26. 20.  Which o f the f o l l o w i n g f a c t o r s i n f l u e n c e d you t o choose a p a r t - t i m e course? |  | c h i l d r e n i n school  |  | wish to be home d u r i n g the day  1  | b a b y - s i t t i n g e a s i e r to arrange i n the evening and on the weekend  |  | h o l d a day-time job  •Q | 1  | more economical t o attend evening/weekend c l a s s e s | need a longer p e r i o d o f time t o study than a l l o w e d i n the f u l l - t i m e course | other ( s p e c i f y )  77  21.  Would you be a b l e to p a r t i c i p a t e i n a concentrated c l i n i c a l e.g., a two week b l o c k , i n the f i n a l weeks o f the course?  I  I  No  |  I  experience  Yes  I f no, l i s t reasons  22.  23.  24.  How l o n g would you expect the p a r t - t i m e course to be? |  | s i x t e e n weeks  1  | e i g h t e e n weeks  |  | twenty weeks  [  | longer, please specify  r  •  How could you BEST meet the requirements f o r theory? [  [ attending classes a t a regional college  |  | u s i n g correspondence  |  | a t t e n d i n g 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 classes at a regional college  |  | v i a c a b l e t e l e v i s i o n a t home  [  | other (specify)  m a t e r i a l a t home television  I f you r e s i d e i n a geographic area o u t s i d e the Lower Mainland how c o u l d you BEST complete the c l i n i c a l and l a b o r a t o r y s e s s i o n s ? |  | n o t a p p 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 t w i c e d u r i n g 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 o f s k i l l s a t my r e g i o n a l c o l l e g e  |  | other (specify)  78  25.  Which o f the f o l l o w i n g times would BEST s u i t your For  Classes:  |  | weekdays 9:00 a.m. to 4:00 p.m.  |  | weekdays 4:00 p.m. t o 7:00 p.m.  |  | weekdays 7:00 p.m. t o 10:00 p.m.  |  1 Saturdays 9:00 a.m. t o 4:00 p.m.  [  | Other ( s p e c i f y )  For  Labs:  |  1 weekdays 9:00 a.m. t o 4:00 p.m.  |  | weekdays 4:00 p.m. t o 7:00 p.m.  |  | weekdays 7:00 p.m. t o 10:00 p.m.  |  | Saturdays 9:00 a.m. to 4:00 p.m.  I  1 Other ( s p e c i f y )  For  C l i n i c a l Practice:  |  1 weekdays 5:00 p.m. to 10:00 p.m.  1  | Saturdays 7:30 a.m. t o 3:30 p.m.  |  ] Saturdays 3:30 p.m. t o 11:30 p.m.  I  1 Other ( s p e c i f y )  Tuti-timz 26.  lifestyle?  .  and PanX-time. pleji&z animeA thz  fallowing:  Do you t h i n k t h e r e a r e some theory areas t h a t you would l i k e t o c h a l l e n g e by w r i t i n g an examination, i n o r d e r t o determine which c l a s s e s you are r e q u i r e d to attend?  I  I No  I  I  Yes  79  27.  Would you be w i l l i n g to have your b a s i c n u r s i n g 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 s e s s i o n would be available).  I  | No  |  | Yes  I f not, l i s t reasons  28.  A r e you a b l e to study independently i . e . , w i t h minimal s u p e r v i s i o n and direction? |  | No  1  ' | Yes  I f not, l i s t reasons  29.  A r e you a b l e to evaluate your progress i n a l e a r n i n g s i t u a t i o n ? |  | No  |  | Yes  I f not, l i s t reasons  30.  31.  How c o n f i d e n t a r e you i n your performance of b a s i c n u r s i n g (Check o n l y one) |  | Can perform b a s i c n u r s i n g s k i l l s , but not without s u p e r v i s i o n and some a s s i s t a n c e .  |  | Can perform b a s i c n u r s i n g s k i l l s but r e q u i r e p e r i o d i c superv i s i o n and/or a s s i s t a n c e .  |  | Can perform b a s i c n u r s i n g s k i l l s w i t h o u t s u p e r v i s i o n and/or assistance.  |  | Don't know  When d i d you put your name on the B.C.I.T. Refresher Month  32.  skills?  constant  Course m a i l i n g l i s t ?  Year  What has been your experience i n a p p l y i n g f o r the B.C.I.T. Refresher 1  | Have never a p p l i e d 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 P u t on the w a i t i n g l i s t b u t not i n t e r v i e w e d  |  | Interviewed  1  | Interviewed and accepted f o r a course, but withdrew before course s t a r t e d  1  1 Interviewed  |  | Other ( s p e c i f y )  f o r a course and placedon the a l t e r n a t e l i s t  but not accepted f o r a course  Course?  80  SECTION V 33.  Do you p l a n t o be employed as a R e g i s t e r e d Nurse as soon as you complete the Refresher Course?  \—J  No  Yes  1j no, proceed t o question 3 7 . j/eA,where i n B.C. do you p l a n t o be employed and i n what c a p a c i t y ? Specify: City Position |  | Full-time  Date of a v a i l a b i l i t y 34.  1  I Part-time  f o r employment  I f you expect t o seek employment i n a General H o s p i t a l f o r what c l i n i c a l a r e a w i l l you be most l i k e l y t o apply? (check one o n l y ) 2  Medical Unit  ]  Surgical Unit  ]  Pediatrics  ]  Obstetrics  "1 P s y c h i a t r y J  Emergency  ]  I.V. Therapy  J  Newborn Nursery  Operating Room Recovery Room Out Patient/Ambulatory  Care  Rehabilitation Renal D i a l y s i s Other ( s p e c i f y )  | Medical/Surgical Intensive Care 35.  I f you do n o t expect t o seek employment i n a General H o s p i t a l , t o what f a c i l i t y w i l l you be most l i k e l y t o apply (check one o n l y ) 1  Children's Hospital  J  Convalescent/Rehab. H o s p i t a l  "] E d u c a t i o n a l F a c i l i t y J  Extended Care H o s p i t a l  ]  H e a l t h U n i t - Home Care Health Unit - Preventative Program Industry  ]  Mental Health/Community Care Team  ]  N u r s i n g Home  J  Physician's Office  3  Psychiatric Hospital  "2 P r i v a t e Duty ~1 Research ~) Other ( s p e c i f y )  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 t o p l a c e on your employment as a R e g i s t e r e d Nurse? Check a l l that apply  |  None  | Weekdays only  Day S h i f t o n l y  | During "school year" o n l y  | Days & Evenings only  I No s t a t u t o r y h o l i d a y s  Evening S h i f t only  ] 8 hour s h i f t s only  Night S h i f t only  ] 12 hour s h i f t s o n l y  Days and n i g h t s o n l y  ] Other ( s p e c i f y )  Evenings & n i g h t s o n l y Subject t o a r r a n g i n g s u i t a b l e c h i l d care Subject t o a v a i l a b i l i t y o f t r a n s p o r t i o n Week-ends only  J& you have. an&weAzd question* 34, 35, 36, ptexuz omit question 37 and continue. ulUjn. question 31.  37.  When you complete the Refresher Course, do you p l a n t o :  38.  |  | become employed i n n u r s i n g a t some f u t u r e date?  |  | seek employment.in n u r s i n g i f i t becomes a f i n a n c i a l n e c e s s i t y ?  |  1 c o n t i n u e your  |  | Other ( s p e c i f y )  education? •  I f you were t o r e t u r n t o work as a R e g i s t e r e d Nurse, what THREE advantages would you a n t i c i p a t e ? P l e a s e rank t h e i r importance t o you by p l a c i n g a " 1 " beside the most imporLant t o 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 t o you. M a i n t a i n n u r s i n g 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 w i t h h e a l t h personnel P r o f e s s i o n a l advancement Financial security Mental s t i m u l a t i o n S o c i a l contacts Other ( s p e c i f y )  82  39.  " I f you were to r e t u r n to work as a R e g i s t e r e d Nurse, what THREE disadvantages would you a n t i c i p a t e ? P l e a s e rank t h e i r importance to you by p l a c i n g a " 1 " b e s i d e the most important t o you, a "2" beside the second most i m p o r t a n t , and a "3" beside the t h i r d most important t o you. I f fewer than t h r e e , p l e a s e rank those t h a t are important t o you. Less time f o r immediate f a m i l y Less time f o r household  activities  Less time f o r s o c i a l , community, and p e r s o n a l a c t i v i t i e s Poor pay - c o s t d i f f e r e n t i a l . Hours o f work Rotating  shifts  Poor p e r s o n n e l  policies  U n s a t i s f a c t o r y standard of p a t i e n t care Too much r e s p o n s i b i l i t y  w i t h o u t enough time and a u t h o r i t y  Inadequate n u r s i n g knowledge Tasks u n r e l a t e d t o n u r s i n g care H e a l t h problems Other  Additional  THANK YOU  (specify)  .  Comments:  FOR  YOUR CO.OPERATION I N 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, i n the following pages. Several comments focussed on perceived changes i n nursing practice and tended to r e f l e c t a degree of ambivalence with respect to the respondent's employment as a registered nurse. ent stated she found the present standard and another that, "the standard  For example, one respond-  of patient care " d i s t r e s s i n g , "  of nursing care c e r t a i n l y has decreased"  and a t h i r d that "most medical-surgical (nursing) situations are overworked and understaffed." Respondents also expressed concern for their own c a p a b i l i t i e s as registered nurses.  Fear of f a i l u r e and of their own a b i l i t y to cope  with changes within the profession characterized t h i s group of comments. "I have this t e r r i b l e thought that I would f a i l because of being out of nursing f o r so long", was an opinion shared by several respondents. Some expressed concern that they could not complete the academic requirements 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 i n nursing.  P a r t i a l updating, "... whereby older nurses could be retrained  enough to s t a f f the extended care u n i t s , " was suggested as an a l t e r native to the present  requirements.  S p e c i a l i z a t i o n within nursing and the d i f f i c u l t i e s of resuming active practice as a registered nurse i n a s p e c i a l t y area a f t e r a period of i n a c t i v i t y was also commented upon.  " I am most interested i n newborn  89 care and would receive no refresher courses concerned with that type of nursing care."  "I worked i n a specialty (psychiatry) and i f I go back  to nursing I would l i k e to return to this area."  "Nursing seems to be  becoming more and more specialized and the refresher course i s 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  i n 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 children at home.  had  Many f e l t they could not cope with f u l l - t i m e study  or f u l l - t i m e employment without, " s a c r i f i c i n g proper care of our families."  A number of suggestions were made with respect to ways i n  which nurses who  saw their f i r s t r e s p o n s i b i l i t y 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 f u l l - t i m e s t a f f and r e l y on o n - c a l l r e l i e f nursing s t a f f to f i l l i n , ... permanent part-time (nurses) on the same s h i f t always take f a r greater pride i n their work and do a better job." The l a s t set of comments related to the s p e c i f i c refresher course i n which they were interested, s p e c i f i c a l l y the admission p o l i c y , the costs associated with the course and with i t s location.  Examples of  comments on admission p o l i c y were: "The recruitment method ... b a f f l e s me;"  "I suggest the present (admission) p o l i c y ... i s chancy, r i s k y  and puts a tremendous s t r a i n on (applicants);" and "I sure would l i k e to get as f a r as having an interview at l e a s t . " The costs of a refresher course, both d i r e c t and i n d i r e c t , were  90 also commented upon. and others."  "The t u i t i o n i s p r o h i b i t i v e and discourages me  "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 p r i n c i p l e of updating knowledge, ...  but what other group charges so much f o r what i s given?"  "Would l i k e  more f i n a n c i a l help to be available f o r single parents who want to go to school to be able to support family better i n the future." Respondents also expressed a desire f o r a refresher course i n other areas of the province. course i n V i c t o r i a . "  "I would be very happy to see a refresher "I f e e l recognized courses should be available  r e a d i l y i n more areas of the province." Lower Mainland,  "For most women outside the  (the present refresher course) i s f i n a n c i a l l y unreal-  i s t i c , considering transportation, room and board, t u i t i o n , plus babys i t t i n g f o r 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. Number  Percent  Total  No employment as R.N. Number  Percent  Number  Percent  5.9  Single  5  5.0  4  7.7  9  Married  86  85.1  42  80.8  128  83.6  Other  10  9.9  6  11.5  16  10.5  101  100.0  52  100.0  153  100.0  Totals X p  = .605  2  <  .05  df = 2  93 TABLE 16  NUMBER AND PERCENTAGE DISTRIBUTION OF INACTIVE NURSE RESPONDENTS BY FUTURE EMPLOYMENT PLAN IN NURSING AND AGE (N=153)  EMPLOYMENT PLAN. IN NURSING  AGE INTERVAL  1  Employment as R.N. Number Percent  Under 35 years  19  35-39 years  No employment as R.N. Number Percent  18.8  7  27  26.7  40-44 years  24  45 years and over  31  Totals  2  101  4  Total  Number Percent  13.5  26  17.0  17  32.7  44  28.8  23.8  14  26.9  38  24.8  30.7  14  26.9  45  29.4  100.0  52  100.0  153  100.0  3  5  1. Intervals were collapsed to ensure adequate numbers i n each c e l l . 2. Includes three respondents i n 25-29 year i n t e r v a l . 3. Includes one respondent i n 25-29 year i n t e r v a l . 4. Includes 13 respondents i n 45-49 year i n t e r v a l , nine i n 50-54 year i n t e r v a l and four over 55 years. 5. Includes seven respondents i n 45-49 year i n t e r v a l , three i n 50-54 year i n t e r v a l 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. Number Percent  No employment as R.N. Number Percent  Total 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. Number Percent  No employment as R.N. Number  Percent  Total 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  

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