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UBC Theses and Dissertations

Staff nurses’ perceptions of the profession of nursing Redekopp, Helen Mary 1985

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STAFF NURSES' PERCEPTIONS OF THE PROFESSION OF NURSING B.S.N., The U n i v e r s i t y o f B r i t i s h C o l u m b i a , 1983 A THESIS SUBMITTED I N PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING THE FACULTY OF GRADUATE STUDIES ( S c h o o l o f 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 c o n f o r m i n g t o t h e r e q u i r e d s t a n d a r d THE UNIVERSITY OF B R I T I S H COLUMBIA O c t o b e r 1985 (cT) H e l e n Mary R e d e k o p p , 1985 By HELEN MARY REDEKOPP i n In presenting t h i s thesis i n p a r t i a l f u l f i l m e n t of the requirements for an advanced degree at the University of B r i t i s h Columbia, I agree that the Library s h a l l make i t f r e e l y available for reference and study. I further agree that permission for extensive copying of t h i s thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. I t i s understood that copying or publication of t h i s thesis for f i n a n c i a l gain s h a l l not be allowed without my written permission. Department of ^)/JtnJ^  The University of B r i t i s h Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3 Date OcrtjJ*,, ///9$<T TYR-fi /""l/R-n i i ABSTRACT I n i t s s t r u g g l e t o be r e c o g n i z e d as a l e g i t i m a t e p r o f e s s i o n , n u r s i n g h a s p r o c e e d e d i n s e v e r a l d i r e c t i o n s , p r o m o t i n g d i v e r s i t y o f p r o f e s s i o n a l v i e w s among i t s p r a c t i t i o n e r s . The many c h a n g e s t a k i n g p l a c e i n n u r s i n g s u p p o r t e d t h e need f o r a s t u d y d e t e r m i n i n g e x a c t l y how s t a f f n u r s e s v i e w t h e p r o f e s s i o n o f n u r s i n g . The c r i t e r i a o f a p r o f e s s i o n as d e f i n e d by V a l i g a ( 1 9 8 2 ) : t h e b o u n d a r i e s , g o a l s , and s c h o l a r l y component o f t h e d i s c i p l i n e , t h e r e c i p i e n t o f t h e d i s c i p l i n e ' s s e r v i c e , t h e r e l a t i o n s h i p o f t h e d i s c i p l i n e t o o t h e r s , and t h e i n d e p e n d e n c e , r e s p o n s i b i l i t y , autonomy, commitment, and a c t i v i t i e s o f t h e d i s c i p l i n e ' s p r a c t i t i o n e r s ( p p . 1 2 6 - 1 2 7 ) , were t h e b a s i s o f t h e s t u d y . The v i e w s o f t h e p r o f e s s i o n as h e l d by t h e s t a f f n u r s e s were r e l a t e d t o t h e v a r i a b l e s o f a g e , p r e p a r a t o r y a n d / o r a d d i t i o n a l n u r s i n g e d u c a t i o n , number o f y e a r s w o r k e d s i n c e g r a d u a t i o n , l e n g t h o f t i m e i n p r e s e n t e m p l o y m e n t , and t h e a g e n c y o f em p l o y m e n t . The 600 s u b j e c t s were r a n d o m l y s e l e c t e d by c o m p u t e r a t t h e 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 o f B r i t i s h C o l u m b i a (R.N.A.B.C.). The V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e , d e v e l o p e d by V a l i g a ( 1 9 8 2 ) , a l o n g w i t h a b a c k g r o u n d i n f o r m a t i o n q u e s t i o n n a i r e were s e n t t o t h e s u b j e c t s by t h e R.N.A.B.C. A t o t a l o f 262 u s a b l e q u e s t i o n n a i r e s were t h e b a s i s o f d a t a a n a l y s i s . P e a r s o n p r o d u c t - m o m e n t c o r r e l a t i o n s and a n a l y s i s o f v a r i a n c e were p e r f o r m e d as a p p r o p r i a t e . These a n a l y s e s r e v e a l e d t h a t t h e r e was an i n v e r s e , b u t n o t s t a t i s t i c a l l y s i g n i f i c a n t , r e l a t i o n s h i p b e t w e e n age and number o f y e a r s w o r k e d and s c o r e s on t h e V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e . T h e r e was no r e l a t i o n s h i p b e t w e e n t h e s c o r e s and e d u c a t i o n and t h e s c o r e s and l e n g t h o f t i m e i n p r e s e n t e m p l o y m e n t . B e c a u s e a l a r g e m a j o r i t y o f r e s p o n d e n t s were e m p l o y e d i n a c u t e c a r e h o s p i t a l s , no a n a l y s i s o f t h e r e l a t i o n s h i p o f a g e n c y o f employment and t h e s c o r e s was u n d e r t a k e n . C o n c l u s i o n s and i m p l i c a t i o n s o f t h i s s t u d y a r e a d d r e s s e d and s u g g e s t i o n s f o r f u r t h e r s t u d y a r e p r e s e n t e d . i v TABLE OF CONTENTS ABSTRACT i i L I S T OF TABLES v i ACKNOWLEDGEMENTS v i i CHAPTER I INTRODUCTION 1 P r o b l e m S t a t e m e n t 4 P u r p o s e o f S t u d y 7 D e f i n i t i o n o f Terms 7 A s s u m p t i o n s 9 L i m i t a t i o n s o f t h e S t u d y 10 CHAPTER I I REVIEW OF THE LITERATURE 12 The P r o f e s s i o n s 12 P r o f e s s i o n a l i z a t i o n 15 N u r s i n g R e s e a r c h R e l a t e d t o t h e P r o b l e m Under S t u d y 17 V a r i a b l e s Under S t u d y 18 N u r s i n g E d u c a t i o n 18 Age 19 Number o f Y e a r s Worked S i n c e G r a d u a t i o n a n d L e n g t h o f Time i n P r e s e n t Employment 20 A g e n c y o f C u r r e n t Employment 21 I n s t r u m e n t s 22 CHAPTER I I I METHODOLOGY 24 I n s t r u m e n t s 24 V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e 24 B a c k g r o u n d I n f o r m a t i o n 27 Sample 27 E t h i c s and Human R i g h t s 28 P r o c e d u r e F o r D a t a C o l l e c t i o n 28 CHAPTER I V DATA ANALYSIS AND DISCUSSION OF FINDINGS 30 I n t r o d u c t i o n 30 R e s p o n s e R a t e 30 V A n a l y s i s o f B a c k g r o u n d I n f o r m a t i o n 31 Age 3 2 N u r s i n g E d u c a t i o n 32 Number o f Y e a r s Worked S i n c e G r a d u a t i o n 36 L e n g t h o f Time i n P r e s e n t Employment 37 A g e n c y o f Employment 37 S c o r i n g o f t h e V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e 39 R e l i a b i l i t y o f t h e V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e 40 V i e w s A b o u t N u r s i n g 41 A n a l y s i s o f V a r i a b l e s i n R e l a t i o n t o S c o r e s 42 Age 43 N u r s i n g E d u c a t i o n 43 Number o f Y e a r s Worked S i n c e G r a d u a t i o n 44 L e n g t h o f Time i n P r e s e n t Employment 45 A g e n c y o f Employment 45 D i s c u s s i o n 47 CHAPTER V SUMMARY, CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS FOR FURTHER STUDY 54 Summary 54 C o n c l u s i o n s 57 I m p l i c a t i o n s 58 R e c o m m e n d a t i o n s F o r F u r t h e r S t u d y 60 REFERENCES 62 APPENDIXES 66 APPENDIX A V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e 67 APPENDIX B B a c k g r o u n d I n f o r m a t i o n 71 APPENDIX C E x p l a n a t o r y L e t t e r 73 L I S T OF TABLES V i T a b l e I F r e q u e n c i e s by Age 33 T a b l e I I F r e q u e n c i e s by H i g h e s t N u r s i n g E d u c a t i o n A t t a i n e d 35 T a b l e I I I F r e q u e n c i e s by Number o f Y e a r s Worked S i n c e G r a d u a t i o n 36 T a b l e I V F r e q u e n c i e s by L e n g t h o f Time i n P r e s e n t Employment 37 T a b l e V F r e q u e n c i e s by A g e n c y o f Employment 38 T a b l e V I F r e q u e n c i e s by S c o r e s on V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e 42 v i i ACKNOWLEDGEMENTS The c o n t r i b u t i o n s o f many i n d i v i d u a l s h ave made p o s s i b l e t h e c o m p l e t i o n o f t h i s t h e s i s . I w o u l d e s p e c i a l l y l i k e t o t h a n k my t h e s i s c o m m i t t e e members Dr. H e l e n N i s k a l a , c h a i r p e r s o n , and D r . M a r i l y n W i l l m a n . I n a d d i t i o n , t h e e n c o u r a g e m e n t and h e l p o f f e r e d b y D r . Mark S t a r r i n t h e d a t a a n a l y s i s i s v e r y much a p p r e c i a t e d . I a p p r e c i a t e t h e a s s i s t a n c e o f C l a i r e K e r m a c k s and t h e 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 o f B r i t i s h C o l u m b i a . A l a r g e d e b t o f g r a t i t u d e i s a l s o due t o t h e members o f t h e R.N.A.B.C. who c o m p l e t e d t h e s e t s o f q u e s t i o n n a i r e s , e s p e c i a l l y t h o s e who e n c l o s e d n o t e s o f e n c o u r a g e m e n t . A s p e c i a l t h a n k s a l s o goes t o B a r b a r a A l b e r t s o n f o r h e r u n e n d i n g p a t i e n c e and s u p p o r t as s h e t y p e d , r e t y p e d and r e t y p e d a g a i n . F i n a l l y , many t h a n k s t o my f a m i l y and f r i e n d s f o r t h e i r o n g o i n g s u p p o r t and u n d e r s t a n d i n g . Thank y o u f o r l i s t e n i n g and c a r i n g . 1 CHAPTER I INTRODUCTION As i s t r u e w i t h many p r o f e s s i o n s , n u r s i n g i s i n a s t a t e of t r a n s i t i o n . In f a c t , some a u t h o r s s t i l l r e f e r t o n u r s i n g as an "emerging" p r o f e s s i o n . S o c i a l and t e c h n o l o g i c a l changes have l e d t o changes i n the p r a c t i c e of n u r s i n g . As new models of n u r s i n g p r a c t i c e r e p l a c e the o l d , e d u c a t o r s , a d m i n i s t r a t o r s , and p r a c t i t i o n e r s a l i k e a r e a t t e m p t i n g t o respond t o the changes a p p r o p r i a t e l y . A l t h o u g h i t i s g e n e r a l l y b e l i e v e d t h a t a l l nurses who graduate from an approved s c h o o l of n u r s i n g have been s o c i a l i z e d i n t o the a t t i t u d e s c h a r a c t e r i s t i c of the p r o f e s s i o n , the o b j e c t i v e measurement of t h e s e a t t i t u d e s i s not o f t e n c a r r i e d o u t , e s p e c i a l l y a f t e r g r a d u a t i o n . A f t e r r e a d i n g V a l i g a ' s s t u d y , e n t i t l e d "The C o g n i t i v e Development and P e r c e p t i o n s About N u r s i n g As A P r o f e s s i o n of B a c c a l a u r e a t e N u r s i n g S t u d e n t s , " i n which the f i n d i n g s i n d i c a t e d t h a t s e n i o r s t u d e n t s ' views of n u r s i n g were more p o s i t i v e than the views of freshman s t u d e n t s on the Views About N u r s i n g 2 Q u e s t i o n n a i r e ( 1 9 8 2 , p. 1 9 4 ) , t h e i n v e s t i g a t o r was l e f t w o n d e r i n g how n u r s i n g g r a d u a t e s m i g h t p e r c e i v e n u r s i n g a f t e r p r a c t i c i n g as s t a f f n u r s e s f o r a p e r i o d o f t i m e . I n f a c t , V a l i g a ( 1 9 8 2) recommends t h a t a l o n g i t u d i n a l s t u d y f o l l o w i n g n u r s e s i n p r a c t i c e o v e r a p e r i o d o f y e a r s w o u l d p r o v i d e v a l u a b l e i n f o r m a t i o n i n r e l a t i o n t o t h e e f f e c t o f t h e e n v i r o n m e n t on t h e i r a t t i t u d e s . She a l s o s u g g e s t s t h a t , s i n c e n u r s i n g e d u c a t o r s e s p o u s e a r e s p o n s i b i l i t y f o r h e l p i n g s t u d e n t s d e v e l o p an a t t i t u d e t o w a r d and a commitment t o n u r s i n g t h a t i s c o n s i s t e n t w i t h t h e c h a r a c t e r i s t i c s o f a p r o f e s s i o n , m e a s u r e s need t o be i n s t i t u t e d w h i c h p r o v i d e e v i d e n c e o f t h e d e g r e e t o w h i c h t h e s e a t t i t u d e s h a v e d e v e l o p e d t h r o u g h o u t v a r i o u s a c a d e m i c y e a r s and w h e t h e r t h e y c o n t i n u e t o d e v e l o p , r e g r e s s , o r s t a b i l i z e o v e r t i m e . K r amer (1974) i d e n t i f i e d t h e " r e a l i t y s h o c k " s t u d e n t n u r s e s e x p e r i e n c e when t h e y g r a d u a t e and become p r a c t i c i n g n u r s e s . R e s e a r c h i n d i c a t e s t h a t " r e a l i t y s h o c k " may, i n f a c t , be due t o a gap b e t w e e n n u r s i n g e d u c a t i o n and n u r s i n g p r a c t i c e ( M e i s e n h e l d e r , 1 9 8 1 ; O l e s e n and W h i t t a k e r , 1 9 6 8 ) . I n t h e i r r e s e a r c h , O l e s e n and W h i t t a k e r ( 1 9 6 8) f o u n d t h a t i n n u r s i n g , as i n e v e r y o t h e r p r o f e s s i o n , t h e r e i s "a gap b e t w e e n t h e c u l t u r e o f t h e p r o f e s s i o n t r a n s m i t t e d i n t h e t e a c h i n g 3 i n s t i t u t i o n and a c t u a l i t i e s o f p r a c t i c e i n s e c t o r s o f t h e f i e l d n ( p . 2 9 7 ) . O l e s e n and W h i t t a k e r a l s o s t a t e t h a t s t u d e n t s a r e not f i n i s h e d p r o d u c t s a t g r a d u a t i o n , s l i d i n g i n p o l i s h e d f a s h i o n f r o m an a s s e m b l y l i n e , b u t a r e , i n f a c t , m i x t u r e s o f a b i l i t y , a c c e p t a n c e o f t h e p r o f e s s i o n a l r o l e , and a w a r e n e s s . S t u d e n t s a r e i n t r u t h l e s s t h a n m a x i m a l l y s o c i a l i z e d , b u t t h e a u t h o r s s u g g e s t t h a t l e s s t h a n maximum s o c i a l i z a t i o n a l l o w s f o r a c e r t a i n f l e x i b i l i t y and a c e r t a i n g i v e i n t h e o n g o i n g c h a n g e s i n t h e p r o f e s s i o n ( p . 2 9 8 ) . However, as much as f l e x i b i l i t y c a n be a d e s i r a b l e t r a i t , i t c a n a l s o be h a r m f u l i n t h a t i t c a n l e a v e a new g r a d u a t e open t o t h e a c q u i s i t i o n o f u n p r o f e s s i o n a l a t t i t u d e s and b e h a v i o r s . I f , i n f a c t , t h e r e i s a g a p , as O l e s e n and W h i t t a k e r have s a i d , i t may be u s e f u l t o d e t e r m i n e t h e e x t e n t o f t h e gap. T h i s s t u d y i s one s t e p i n t h a t d i r e c t i o n . S i n c e i n s t i t u t i o n a l s t a f f n u r s e s c o m p r i s e t h e l a r g e s t g r o u p o f e m p l o y e d n u r s e s , i t i s u s e f u l t o d e t e r m i n e how t h e y v i e w t h e e s s e n t i a l c h a r a c t e r i s t i c s o f a p r o f e s s i o n . i n t h i s s t u d y , t h e c h a r a c t e r i s t i c s o f a p r o f e s s i o n a r e t h o s e d e f i n e d by V a l i g a ( 1 9 8 2 ) : t h e b o u n d a r i e s o f t h e d i s c i p l i n e , r e c i p i e n t o f t h e d i s c i p l i n e ' s s e r v i c e , g o a l s o f t h e d i s c i p l i n e , s c h o l a r l y component o f t h e d i s c i p l i n e , t h e r e l a t i o n s h i p 4 o f t h e d i s c i p l i n e t o o t h e r s , and t h e i n d e p e n d e n c e , r e s p o n s i b i l i t y , autonomy, commitment, and a c t i v i t i e s o f t h e d i s c i p l i n e ' s p r a c t i t i o n e r s ( p p . 1 2 6 - 1 2 7 ) . P r o b l e m S t a t e m e n t H i s t o r i c a l l y , t h e a t t r i b u t e s o f o b e d i e n c e , s u b s e r v i e n c e , and d e v o t i o n were a s s o c i a t e d w i t h p r o f e s s i o n a l n u r s i n g p r a c t i c e ( G r e i n e r , 1 9 8 1 ) . N u r s e s were v i e w e d as h a n d m a i d e n s t o p h y s i c i a n s and c o m p a s s i o n a t e a n g e l s o f m e r c y who f o l l o w e d o r d e r s ( M u f f , 1 9 8 2 ) . Over t i m e , n u r s i n g h a s s t r u g g l e d t o be r e c o g n i z e d as a l e g i t i m a t e p r o f e s s i o n , and t o d a y i s e v o l v i n g a s a s c i e n t i f i c d i s c i p l i n e . I n t h e s t r u g g l e t o be r e c o g n i z e d as a l e g i t i m a t e p r o f e s s i o n , n u r s i n g and n u r s e s h a v e p r o c e e d e d i n s e v e r a l d i r e c t i o n s and c o n t i n u e t o do s o . P r e s e n t l y , a t t e m p t s a r e b e i n g made i n s u c h a r e a s as e s t a b l i s h i n g t h e b a c c a l a u r e a t e d e g r e e as t h e e n t r y l e v e l f o r p r o f e s s i o n a l n u r s i n g p r a c t i c e , d e f i n i n g t h e b o u n d a r i e s o f n u r s i n g p r a c t i c e , and e n g a g i n g i n s c h o l a r l y a c t i v i t i e s d e s i g n e d t o d e v e l o p a body o f n u r s i n g k n o w l e d g e ( V a l i g a , 1 9 8 2 ) . I n an a t t e m p t t o a s s e r t i t s p r o f e s s i o n a l s t a t u s , 5 n u r s i n g h a s f o c u s e d much o f i t s a t t e n t i o n on t h e e d u c a t i o n o f i t s f u t u r e members where p r o f e s s i o n a l a t t i t u d e s a r e b e l i e v e d t o be f o r m e d . U n f o r t u n a t e l y , t h e d i v e r s i t y c r e a t e d by d i f f e r e n t p a t t e r n s and l e v e l s o f e d u c a t i o n f o r t h e p r o f e s s i o n h a s p r o d u c e d many d i f f e r e n t t y p e s o f n u r s e s and now t h e g r o u p s t h r e a t e n e a c h o t h e r and f r a g m e n t t h e p r o f e s s i o n ( M c C l o s k e y , 1 9 8 3 ) . I n f a c t , t h e d i v e r s i t y i s so g r e a t t h a t g r o u p s o f n u r s e s f a l l on o p p o s i t e ends o f a c o n t i n u u m . F o r some, n u r s i n g i s "a p r o f e s s i o n t h a t i s a u t o n o m o u s , s e l f - d i r e c t e d , r e q u i r i n g a d v a n c e d p r e p a r a t i o n o f i t s p r a c t i t i o n e r s , and e n c o m p a s s e s b r o a d s o c i a l r e s p o n s i b i l i t i e s . F o r o t h e r s , n u r s i n g i s a p e r s o n a l s e r v i c e r e n d e r e d by t h e n u r s e t o t h e p a t i e n t , u n d e r t h e s u p e r v i s i o n o f t h e p h y s i c i a n " ( M c C l o s k e y , 1 9 8 3 , p. 5 3 ) . A l t h o u g h t h e p r o d u c t i o n o f i d e n t i c a l , r o b o t - l i k e i n d i v i d u a l s p r a c t i c i n g n u r s i n g i s n o t d e s i r a b l e , t h e e s s e n t i a l c h a r a c t e r i s t i c s o f a p r o f e s s i o n as d e f i n e d by V a l i g a ( 1 9 8 2 ) and o u t l i n e d p r e v i o u s l y , s h o u l d be v i e w e d s i m i l a r l y , i f , i n f a c t , n u r s i n g i s p u r s u i n g p r o f e s s i o n a l r e c o g n i t i o n . The i n v e s t i g a t o r a g r e e s w i t h Conway ( 1 9 8 3 ) , i n t h a t : N u r s i n g i s a p r o f e s s i o n w h i c h f r o m a 6 s o c i o - e v o l u t i o n a r y p e r s p e c t i v e i s s t i l l d e v e l o p i n g i t s p r o f e s s i o n a l i d e n t i t y . T h a t i s , i t i s c o n t i n u i n g t o d e f i n e i t s p a r a m e t e r s o f p r a c t i c e and t o d e l i m i t t h o s e p a r a m e t e r s v i s - a - v i s o t h e r h e a l t h p r o f e s s i o n s . T h u s , i t seems a p p r o p r i a t e — e v e n n e c e s s a r y — t o e x a m i n e how n u r s i n g i s p r o c e e d i n g i n i t s p u r s u i t o f r e c o g n i t i o n as a f u l l y q u a l i f i e d p r o f e s s i o n ( p . 2 9 ) . I t i s e s p e c i a l l y a p p r o p r i a t e a t t h i s t i m e t o f o c u s a s t u d y on s t a f f n u r s e s who work i n i n s t i t u t i o n s b e c a u s e t h a t i s w here t h e m a j o r i t y o f n u r s e s p r a c t i c e ( C u n n i n g h a m , 1 9 8 0 ) . S i n c e i t i s d i f f i c u l t t o d e t e r m i n e r e t r o s p e c t i v e l y how s t a f f n u r s e s p e r c e i v e d n u r s i n g w h i l e t h e y were i n t h e i r r e s p e c t i v e e d u c a t i o n a l s e t t i n g s , t h e s t u d y must be c o n c e r n e d o n l y w i t h c u r r e n t p e r c e p t i o n s . The many c h a n g e s t a k i n g p l a c e i n n u r s i n g s u p p o r t t h e need f o r a s t u d y d e t e r m i n i n g e x a c t l y how n u r s e s v i e w n u r s i n g i n r e l a t i o n t o t h o s e c r i t e r i a d e f i n e d as p r o f e s s i o n a l . The i d e n t i f i c a t i o n o f s i m i l a r i t i e s and d i f f e r e n c e s i n t h e v i e w s may s u g g e s t a c t i o n s w h i c h s h o u l d be t a k e n i n n u r s i n g e d u c a t i o n a l o r p r a c t i c e s e t t i n g s o r may p r o v i d e d i r e c t i o n f o r f u r t h e r s t u d y . The p r o b l e m w h i c h i s t h e f o c u s o f t h i s s t u d y , t h e n , c a n be s t a t e d as f o l l o w s : What a r e s t a f f n u r s e s ' p e r c e p t i o n s o f t h e p r o f e s s i o n o f n u r s i n g ? U s i n g t h e c o m p o n e n t s o f p r o f e s s i o n a l n u r s i n g , as d e f i n e d by V a l i g a , t h e p e r c e p t i o n s o f a g r o u p o f s t a f f n u r s e s were s t u d i e d . P u r p o s e o f S t u d y The p u r p o s e s o f t h e s t u d y w e r e : 1. To d e t e r m i n e s t a f f n u r s e s ' p e r c e p t i o n s o f t h e p r o f e s s i o n o f n u r s i n g , as d e f i n e d by V a l i g a . 2. To d e t e r m i n e s t a f f n u r s e s ' p e r c e p t i o n s o f n u r s i n g i n r e l a t i o n t o t h e v a r i a b l e s o f a g e , p r e p a r a t o r y n u r s i n g e d u c a t i o n a n d / o r a d d i t i o n a l p r e p a r a t i o n , number o f y e a r s w o r k e d s i n c e g r a d u a t i o n , l e n g t h o f t i m e i n p r e s e n t e m p l o y m e n t , and t y p e o f f a c i l i t y i n w h i c h p r e s e n t l y e m p l o y e d . D e f i n i t i o n o f Terms F o r t h e p u r p o s e o f t h i s s t u d y , t h e f o l l o w i n g d e f i n i t i o n s were u s e d : S t a f f n u r s e was d e f i n e d as a p e r s o n who i s a g r a d u a t e o f an a p p r o v e d s c h o o l o f n u r s i n g , who i s 8 r e g i s t e r e d as a member o f t h e 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 o f B r i t i s h C o l u m b i a (R.N.A.B.C.) and l i c e n s e d t o p r a c t i c e n u r s i n g i n B r i t i s h C o l u m b i a , and i s c u r r e n t l y e m p l o y e d f u l l - t i m e i n an i n s t i t u t i o n as a g e n e r a l d u t y n u r s e , h a v i n g been so e m p l o y e d f o r a minimum o f s i x months. I n s t i t u t i o n was d e f i n e d as an a c u t e c a r e h o s p i t a l , an a c t i v a t i o n / r e h a b i l i t a t i o n h o s p i t a l , a p s y c h i a t r i c h o s p i t a l , o r a l o n g t e r m c a r e f a c i l i t y ( p e r s o n a l , i n t e r m e d i a t e , e x t e n d e d c a r e , and n u r s i n g h o m e s ) . The t e n e s s e n t i a l c h a r a c t e r i s t i c s o f a p r o f e s s i o n as d e f i n e d b y V a l i g a ( 1 9 8 2 ) a r e : B o u n d a r i e s o f t h e D i s c i p l i n e : The d e f i n i t i o n o f t h e s c o p e o f t h e d i s c i p l i n e i s c l e a r . R e c i p i e n t o f t h e D i s c i p l i n e ' s S e r v i c e : The o b j e c t o f a t t e n t i o n o f t h e d i s c i p l i n e i s u n a m b i g u o u s . G o a l s o f t h e D i s c i p l i n e : The r e a s o n s why members o f t h e d i s c i p l i n e do what t h e y do a r e u n a m b i g u o u s . R e l a t i o n s h i p o f t h e D i s c i p l i n e t o O t h e r s : R e l a t i o n s among r e a l - w o r l d e l e m e n t s a r e e x p l i c i t . I n d e p e n d e n c e o f t h e D i s c i p l i n e ' s P r a c t i t i o n e r s : 9 Members o f t h e d i s c i p l i n e f u n c t i o n i n d e p e n d e n t l y . R e s p o n s i b l i t y o f t h e D i s c i p l i n e ' s P r a c t i t i o n e r s : The d i s c i p l i n e h a s w e l l - d e f i n e d s t a n d a r d s and e t h i c a l c o d e s , and members o f t h e d i s c i p l i n e a r e r e s p o n s i b l e and a c c o u n t a b l e f o r t h e i r a c t i o n s . S c h o l a r l y Component o f t h e D i s c i p l i n e : The d i s c i p l i n e h a s a u n i q u e body o f k n o w l e d g e and a s c h o l a r l y c omponent. Autonomy o f t h e D i s c i p l i n e ' s P r a c t i t i o n e r s : Members o f t h e d i s c i p l i n e a r e a u t o n o m o u s . Commitment o f t h e D i s c i p l i n e ' s P r a c t i t i o n e r s : Members o f t h e d i s c i p l i n e h a v e a l i f e t i m e commitment t o i t . A c t i v i t i e s o f t h e D i s c i p l i n e ' s P r a c t i t i o n e r s : The d i s c i p l i n e o f f e r s a u n i q u e s e r v i c e t o s o c i e t y , and t h e c h a r a c t e r i s t i c s o f what members o f t h e d i s c i p l i n e do a r e u n a m b i g u o u s (p p . 1 2 6 - 1 2 7 ) . A s s u m p t i o n s The f o l l o w i n g a s s u m p t i o n s a r e r e l e v a n t t o t h i s s t u d y : 1. The d e f i n i t i o n o f a p r o f e s s i o n , as s e t 10 f o r t h b y V a l i g a , i s v a l i d and a t l e a s t t h e m a j o r e l e m e n t s a r e a g r e e d upon by a l a r g e number o f n u r s e s . 2. A l l s u b j e c t s were s o c i a l i z e d as s t u d e n t s t o e s p o u s e a t l e a s t some o f t h e p r o f e s s i o n a l c h a r a c t e r i s t i c s i d e n t i f i e d by V a l i g a . 3. R e s p o n d e n t s a n s w e r e d t h e q u e s t i o n n a i r e h o n e s t l y and t o t h e b e s t o f t h e i r a b i l i t y . 4 . R e s p o n d e n t s had t h e a b i l i t y t o a s s e s s t h e i r p e r c e p t i o n s a c c u r a t e l y . L i m i t a t i o n s o f t h e S t u d y L i m i t a t i o n s o f t h i s s t u d y r e l a t e t o t h e f o l l o w i n g : 1. N u r s e s who r e s p o n d e d t o t h e q u e s t i o n n a i r e may n o t be r e p r e s e n t a t i v e o f a l l n u r s e s and t h e g e n e r a l i z a b i l i t y o f t h e r e s u l t s may t h e r e f o r e be l i m i t e d . 2. The V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e h a s i t s l i m i t a t i o n s i n m e a s u r i n g p e r c e p t i o n s o f t h e p r o f e s s i o n o f n u r s i n g b e c a u s e i t i s a s e l f - r e p o r t i n s t r u m e n t . 3. The s t u d y s a m p l e does n o t i n c l u d e n u r s e s who work i n i n s t i t u t i o n s o t h e r t h a n t h o s e s p e c i f i e d . 4. P e r c e p t i o n s of the s u b j e c t s a r e tho se h e l d at t h i s p o i n t i n t i m e . No a t tempt was made t o s t udy changes over t i m e . 12 CHAPTER II REVIEW OF THE LITERATURE The aim of t h i s l i t e r a t u r e review was to expl o r e the t h e o r e t i c a l p e r s p e c t i v e of p r o f e s s i o n a l i z a t i o n as a background f o r the study of s t a f f nurses' p e r c e p t i o n s of the p r o f e s s i o n of n u r s i n g . A review of the l i t e r a t u r e r e l a t i n g to the concepts " p r o f e s s i o n " and " p r o f e s s i o n a l i z a t i o n " as we l l as n u r s i n g research r e l a t e d s p e c i f i c a l l y to the t o p i c of t h i s study was conducted and i s presented here. The P r o f e s s i o n s Many authors have addressed the i s s u e of p r o f e s s i o n a l i s m and the c h a r a c t e r i s t i c s or a t t r i b u t e s of p r o f e s s i o n s . Greenwood (1957) suggests that a l l occupations i n s o c i e t y should be d i s t r i b u t e d along a continuum with the w e l l - r e c o g n i z e d and undisputed p r o f e s s i o n s , such as medicine and law on one end, the l e a s t s k i l l e d and l e a s t a t t r a c t i v e occupations on the other and the remaining occupations between the two p o l e s . The occupations at the p r o f e s s i o n a l end of the continuum are seen to possess to a maximum degree the 13 a t t r i b u t e s a s c r i b e d t o p r o f e s s i o n s . F o r s e v e r a l d e c a d e s , s o c i o l o g i s t s h a v e a t t e m p t e d t o d e f i n e e x a c t l y t h e a t t r i b u t e s o f p r o f e s s i o n s . A l t h o u g h many a u t h o r s a g r e e on some o f t h e a t t r i b u t e s , none a g r e e on a l l . L e w i s and Maude ( 1 9 5 2 ) s t a t e t h a t a p r o f e s s i o n s h o u l d h a v e a body o f k n o w l e d g e , e d u c a t i o n b a s e d on t h a t k n o w l e d g e , s t a n d a r d s f o r p r o f e s s i o n a l q u a l i f i c a t i o n s , a s t a n d a r d o f c o n d u c t , r e c o g n i t i o n o f s t a t u s , and t h e o r g a n i z a t i o n o f t h e p r o f e s s i o n a l g r o u p . Greenwood ( 1 9 5 7 ) b e l i e v e s t h a t a l l p r o f e s s i o n s p o s s e s s t h e a t t r i b u t e s o f : (1) s y s t e m a t i c t h e o r y ; (2) a u t h o r i t y ; ( 3 ) community s a n c t i o n ; ( 4 ) e t h i c a l c o d e s ; and ( 5 ) a c u l t u r e ( p . 4 5 ) . J o h n s o n ( 1 9 7 2 ) adds t h a t p r o f e s s i o n s f o l l o w a n a t u r a l h i s t o r y , and d e s c r i b e s p r o f e s s i o n s i n t h e U n i t e d S t a t e s as h a v i n g p a s s e d t h r o u g h f i v e s t a g e s , n a m e l y , (1) t h e em e r g e n c e o f a f u l l - t i m e o c c u p a t i o n ; (2) t h e e s t a b l i s h m e n t o f a t r a i n i n g s c h o o l ; (3) t h e f o u n d i n g o f a p r o f e s s i o n a l a s s o c i a t i o n ; (4) p o l i t i c a l a g i t a t i o n d i r e c t e d t o w a r d s t h e p r o t e c t i o n o f t h e a s s o c i a t i o n by l a w ; and (5) t h e a d o p t i o n o f a f o r m a l c o d e ( p . 2 8 ) . M c G l o t h l i n ( 1 9 6 0 ) i d e n t i f i e d t h e a i m s o f p r o f e s s i o n a l e d u c a t i o n as b e i n g t w o f o l d : o n e , t o s u p p l y enough p r o f e s s i o n a l p e o p l e , a n d , two, t o a s s u r e s o c i e t y t h a t t h e p r o f e s s i o n a l s a r e c o m p e t e n t t o p r a c t i c e t h e i r p r o f e s s i o n ( p . 2 ) . He s t a t e d t h a t p r o f e s s i o n a l s must p o s s e s s t h e f o l l o w i n g a t t r i b u t e s : (1) c o m p e t e n c e t o p r a c t i c e t h e p r o f e s s i o n ; ( 2 ) s o c i a l u n d e r s t a n d i n g , w i t h s u f f i c i e n t b r e a d t h t o p l a c e t h e i r p r a c t i c e i n t h e c o n t e x t o f t h e s o c i e t y w h i c h s u p p o r t s i t , and t o d e v e l o p c a p a c i t y f o r l e a d e r s h i p i n p u b l i c a f f a i r s ; ( 3 ) p e r s o n a l i t y c h a r a c t e r i s t i c s t h a t make p o s s i b l e e f f e c t i v e p r a c t i c e and e f f e c t i v e l i v i n g ; ( 4 ) z e s t f o r c o n t i n u e d s t u d y w h i c h w i l l s t e a d i l y i n c r e a s e k n o w l e d g e and s k i l l r e q u i r e d t o p r a c t i c e ; and ( 5 ) c o m p e t e n c e i n c o n d u c t i n g o r i n t e r p r e t i n g r e s e a r c h so t h a t t h e y c a n add t o human k n o w l e d g e e i t h e r t h r o u g h d i s c o v e r y o r a p p l i c a t i o n o f new t r u t h s ( p p . 7 - 2 2 ) . V a l i g a ( 1 9 8 2) s u m m a r i z e d t h e a t t r i b u t e s o f p r o f e s s i o n s as f o l l o w s : a body o f s p e c i a l i z e d k n o w l e d g e d e v e l o p e d by members o f t h e p r o f e s s i o n ; e d u c a t i o n f o r e n t r y i n t o t h e p r o f e s s i o n o c c u r r i n g a t t h e u n i v e r s i t y l e v e l ; t h e k n o w l e d g e and s k i l l n e c e s s a r y t o p r o v i d e h e l p i n a s p e c i a l i z e d a r e a w i t h p r o b l e m s t h a t h a v e u n i q u e and u n p r e d i c t a b l e e l e m e n t s ; a code o f e t h i c s t o g u i d e p r a c t i c e ; c o n t r o l o v e r t h e p r a c t i c e o f members o f t h e p r o f e s s i o n ; t h e e x e r c i s e o f d i s c r e t i o n ; commitment t o t h e f i e l d ; and t h e p r i m a r y o r i e n t a t i o n t o w a r d t h e community r a t h e r t h a n s e l f - i n t e r e s t ( p . 7 5 ) . From t h e s e , V a l i g a d e v e l o p e d t h e t e n e s s e n t i a l c h a r a c t e r i s t i c s o f a p r o f e s s i o n u t i l i z e d as t h e b a s i s f o r t h i s s t u d y . P r o f e s s i o n a l i z a t i o n K e r g i n ( 1 9 6 8) b e l i e v e s t h a t p r o f e s s i o n a l i z a t i o n i s t h e movement o f a v o c a t i o n a l g r o u p a l o n g t h e o c c u p a t i o n a l c o n t i n u u m as i t s members d e v e l o p more and more o f t h o s e a t t r i b u t e s t h a t c h a r a c t e r i z e t h e p r o f e s s i o n a l ( p . 2 2 ) . J o h n s o n ( 1 9 7 2 ) s u g g e s t s t h a t t h e p r o c e s s o f p r o f e s s i o n a l i z a t i o n i s a d y n a m i c one w h i c h i s e v i d e n t i n many o c c u p a t i o n s when c e r t a i n c r u c i a l c h a r a c t e r i s t i c s a r e c h a n g e d i n an a t t e m p t t o move t h e o c c u p a t i o n . f u r t h e r a l o n g t h e c o n t i n u u m , i n t h e d i r e c t i o n o f p r o f e s s i o n a l i z a t i o n ( p . 2 2 ) . N u r s e s i n Canada a r e c u r r e n t l y e x p e r i e n c i n g t h i s d y n a m i c p r o c e s s as t h e y s t r i v e f o r p r o f e s s i o n a l i d e n t i t y . Hughes (1960) p o i n t s o u t t h a t t h e s t u d y o f p r o f e s s i o n a l i z a t i o n i s i n p a r t a s t u d y o f two k i n d s o f s o c i a l a d v a n c e m e n t . "The f i r s t i s a r i s e o f t h e i n d i v i d u a l by g e t t i n g i n t o an o c c u p a t i o n o f h i g h p r e s t i g e , o r by a c h i e v i n g s u c c e s s i n h i s o c c u p a t i o n . 16 The s e c o n d i s t h e c o l l e c t i v e e f f o r t o f an o r g a n i z e d o c c u p a t i o n t o i m p r o v e i t s p l a c e and i n c r e a s e i t s power, i n r e l a t i o n t o o t h e r s " ( p . 5 6 ) . Hughes ( 1 9 6 0 ) a l s o s u g g e s t s t h a t t h e f o u r m a i n methods o f a c h i e v i n g p r o f e s s i o n a l s t a t u s i n c l u d e : (1) r e q u i r i n g more s c h o o l i n g ; ( 2 ) i n s i s t i n g t h a t t h e members o f t h e o c c u p a t i o n and n o t some o u t s i d e a u t h o r i t y s h o u l d d e f i n e t h e i r w o r k ; (3) p l a c i n g t h e r o u t i n e d u t i e s a s s o c i a t e d w i t h t h e j o b on t h e s h o u l d e r s o f s u b o r d i n a t e s ; a n d (4) e n g a g i n g i n o r s u p p o r t i n g r e s e a r c h a c t i v i t i e s ( p . 5 7 ) . As n u r s i n g c o n t i n u e s t o s t r u g g l e f o r p r o f e s s i o n a l i d e n t i t y , i t i s u s e f u l t o o c c a s i o n a l l y e v a l u a t e i t s c u r r e n t p o s i t i o n . S t u a r t ( 1 9 8 1 ) s t u d i e d t h e d e g r e e o f p r o f e s s i o n a l i z a t i o n o f n u r s i n g i n t h e U n i t e d S t a t e s . She f o u n d t h a t , a l t h o u g h n u r s i n g i s a w e l l - e s t a b l i s h e d o c c u p a t i o n w i t h a c l e a r s e r v i c e o r i e n t a t i o n and h a s an o r g a n i z a t i o n r e p r e s e n t i n g t h e p r o f e s s i o n , t h e m e m b e r s h i p i n t h e p r o f e s s i o n a l o r g a n i z a t i o n i s l o w ; t h e r e a r e few w i t h a l i f e - l o n g commitment t o t h e p r o f e s s i o n ; i n d i v i d u a l autonomy i s l i m i t e d b e c a u s e o f b u r e a u c r a t i c work s e t t i n g s ; a n d , a l t h o u g h g r e a t s t r i d e s a r e b e i n g made i n t h e e d u c a t i o n o f i t s members, t h e p r o f e s s i o n r e m a i n s weak b e c a u s e o f i t s v a r i e t y o f e d u c a t i o n a l p r o g r a m s ( p . 2 3 ) . S m i t h ( 1 9 5 8 ) d e s c r i b e s t h e p r o b l e m s s u r r o u n d i n g a t t e m p t s a t p r o f e s s i o n a l i z a t i o n and a d v i s e s t h a t when members o f a p r o f e s s i o n a r e s p e a r h e a d i n g moves t o cha n g e i t s s t a t u s , t h e y must t a k e a c c o u n t o f t h e p o s s i b l e r e s i s t a n c e s w i t h i n t h e i r own p r o f e s s i o n . Members may be c o n t e n t w i t h t h e s u c c e s s o r r e c o g n i t i o n o f t h e i r p r e s e n t s k i l l s . D r a s t i c c h a n g e s i n t h e s y s t e m may i n v i t e new c o m p e t i t i o n o r r e q u i r e more e d u c a t i o n , p o s s i b l y t h r e a t e n i n g i n d i v i d u a l s ( p . 4 1 2 ) . O b v i o u s l y t h e c h a n g e s p r e s e n t l y o c c u r r i n g i n t h e n u r s i n g p r o f e s s i o n may a f f e c t some o f i t s members i n t h i s way. N u r s i n g R e s e a r c h R e l a t e d t o The P r o b l e m Under S t u d y V e r y few s t u d i e s h a v e i n v e s t i g a t e d n u r s e s * p e r c e p t i o n s o f t h e p r o f e s s i o n . Of t h e few t h a t h a v e b e e n done, t h e m a j o r i t y h a v e i n v o l v e d s t u d e n t s . The l i t e r a t u r e s u g g e s t s t h a t e d u c a t i o n , a g e , t i m e s i n c e g r a d u a t i o n , l e n g t h o f t i m e i n t h e c u r r e n t a r e a o f e m p l o y m e n t , and t h e a g e n c y i n w h i c h n u r s e s a r e c u r r e n t l y e m p l o y e d may i n f l u e n c e t h e i r p e r c e p t i o n s o f t h e p r o f e s s i o n o f n u r s i n g . V a r i a b l e s Under S t u d y N u r s i n g E d u c a t i o n R e s e a r c h i n d i c a t e s t h a t e d u c a t i o n i s a v i t a l i n f l u e n c e on a n u r s e ' s p e r c e p t i o n o f t h e p r o f e s s i o n . K e r g i n ' s s t u d y ( 1 9 6 8 ) o f 719 O n t a r i o n u r s e s c o n f i r m e d t h i s , i n t h a t , e x c e p t f o r t h e v a r i a b l e i d e n t i f y i n g s a t i s f a c t i o n w i t h c a r e e r c h o i c e , e d u c a t i o n was f o u n d t o be t h e most i m p o r t a n t v a r i a b l e o f t h e t w e l v e i d e n t i f i e d a t t r i b u t e s o f t h e h i g h l y p r o f e s s i o n a l i z e d n u r s e . R o t t k a m p (1980) a l s o f o u n d t h a t 9 6 . 5 % o f t h e g r a d u a t e n u r s i n g s t u d e n t s she s u r v e y e d a g r e e d w i t h t h e d e f i n i t i o n o f p r o f e s s i o n a l n u r s i n g s e t f o r t h by t h e New Y o r k N u r s e s ' A s s o c i a t i o n , b e l i e v i n g t h a t " n u r s i n g i s a p r o f e s s i o n t h a t i s a u t o n o m o u s , s e l f - d i r e c t e d , r e q u i r i n g a d v a n c e d p r e p a r a t i o n o f i t s p r a c t i t i o n e r s , and e n c o m p a s s e s b r o a d s o c i a l r e s p o n s i b i l i t i e s " ( p . 3 2 ) . A s t u d y o f b a c c a l a u r e a t e n u r s i n g s t u d e n t s , done by D a v i s and O l e s e n ( 1 9 64) and r e p l i c a t e d by B r o w n , S w i f t , a n d Oberman ( 1 9 7 4 ) , r e v e a l e d t h a t s t u d e n t s m o d i f i e d t h e i r o r i g i n a l l a y c o n c e p t i o n s so as t o a c c o r d more c l o s e l y w i t h t h e p r o f e s s i o n a l v i e w s and a t t i t u d e s o f t h e i r t e a c h e r s and p r e c e p t o r s . As t h e e d u c a t i o n a l p r o c e s s c o n t i n u e d , s t u d e n t s ' c o n s e n s u s w i t h r e g a r d t o v a l u e s i n c r e a s e d f o r b o t h g r o u p s s t u d i e d , b u t t h e e d u c a t i o n a l p r o c e s s d i d n o t i n c r e a s e t h e p o s i t i v e p e r c e p t i o n s o f t h e p r o f e s s i o n o f e i t h e r g r o u p . C o r w i n and T a v e s ( 1 9 6 2 ) s t u d i e d t h e r o l e c o n c e p t i o n s o f 124 s t a f f n u r s e s and 71 j u n i o r and s e n i o r n u r s i n g s t u d e n t s w i t h d i p l o m a and d e g r e e t r a i n i n g f r o m s e v e n m i d w e s t m e t r o p o l i t a n a r e a h o s p i t a l s and f o u r s c h o o l s o f n u r s i n g . I t was c o n c l u d e d t h a t t h e p r o f e s s i o n a l r o l e c o n c e p t i o n , i n c l u d i n g a commitment t o k n o w l e d g e as a b a s i s o f t h e p r o f e s s i o n , t h e a b i l i t y t o use j u d g e m e n t , and a u t h o r i t y t o make s u g g e s t i o n s a b o u t n u r s i n g c a r e and p r o c e d u r e s i s h i g h among b a c c a l a u r e a t e - p r e p a r e d n u r s e s and r e m a i n s r e l a t i v e l y h i g h a f t e r g r a d u a t i o n i n s p i t e o f t h e l a c k o f o p p o r t u n i t y t o f u l f i l l i t . T h i s was l e s s t r u e o f d i p l o m a - p r e p a r e d n u r s e s . Age A n o t h e r f a c t o r i d e n t i f i e d a s h a v i n g an i n f l u e n c e on how n u r s e s p e r c e i v e t h e p r o f e s s i o n o f n u r s i n g i s a g e , y e t few s t u d i e s h a v e a s s e s s e d t h e i n f l u e n c e o f t h i s v a r i a b l e . K e r g i n ( 1 9 6 8 ) f o u n d t h a t as age i n c r e a s e s so d o e s t h e o c c u p a t i o n a l commitment. T e t r e a u l t ( 1 9 7 6) f o u n d t h a t s t u d e n t s b e t w e e n t h e a g e s o f 24 and 26 y e a r s had more p o s i t i v e a t t i t u d e s t o w a r d s 20 n u r s i n g t h a n d i d y o u n g e r s t u d e n t s . Number o f y e a r s w o r k e d s i n c e g r a d u a t i o n and l e n g t h o f  t i m e i n p r e s e n t employment A l t h o u g h t h e l i t e r a t u r e i s l i m i t e d , i t does s u g g e s t t h a t t h e number o f y e a r s w o r k e d s i n c e g r a d u a t i o n and t h e l e n g t h o f t i m e i n t h e c u r r e n t a r e a o f employment i n f l u e n c e n u r s e s ' p e r c e p t i o n s o f t h e i r p r o f e s s i o n . Kramer ( 1 9 6 6 ) s t u d i e d a g r o u p o f 45 s t a f f n u r s e s who had g r a d u a t e d f r o m t h r e e C a l i f o r n i a c o l l e g e s a t l e a s t t h r e e months e a r l i e r and were now e m p l o y e d i n t h e i r f i r s t j o b . She f o u n d t h a t , a l t h o u g h t h e r e were b u r e a u c r a t i c d r a w - b a c k s , s u c h as r i g i d r o u t i n e s t h a t made work s t i f l i n g , u n c r e a t i v e , and c o n f i n i n g , and u n p l e a s a n t work s c h e d u l e s , t h e y o u n g g r a d u a t e s seemed more o r i e n t e d and l o y a l t o t h e p r o f e s s i o n o f n u r s i n g t h a n t o any p a r t i c u l a r p l a c e o f employment. Two y e a r s l a t e r , when she r e p e a t e d t h e s t u d y w i t h t h e same n u r s e s , s he f o u n d t h a t , a f t e r c o n t i n u e d e m p l o y m e n t , n u r s e s who i n i t i a l l y h e l d h i g h p r o f e s s i o n a l r o l e c o n c e p t i o n s showed a s i g n i f i c a n t d e c l i n e i n t h e s e v a l u e s ( K r a m e r , 1 9 6 9 ) . 21 A g e n c y o f C u r r e n t Employment E v i d e n c e i n d i c a t e s t h a t t h e a t t i t u d e s o f s t a f f n u r s e s e m p l o y e d i n i n s t i t u t i o n s a r e v e r y much a f f e c t e d by t h e a g e n c y i n w h i c h t h e y a r e e m p l o y e d . Kramer (1970) m a i n t a i n s t h a t " t h e n e o p h y t e p r o f e s s i o n a l n u r s e e n c o u n t e r s d i f f i c u l t y w i t h h e r p r o f e s s i o n a l r o l e o r i e n t a t i o n a l m o s t i m m e d i a t e l y upon e m p l o y m e n t " ( p . 4 3 5 ) . Q u i n t ( 1 9 6 7 ) a l s o i m p l i e s t h i s i n h e r d i s c u s s i o n o f s t u d e n t s m e e t i n g c o n f l i c t s when o b s e r v i n g r o l e m o d e l s i n t h e e d u c a t i o n a l s e t t i n g t h a t d i f f e r f r o m r o l e m o d e l s i n c l i n i c a l s e t t i n g s . S i m p s o n ( 1 9 7 9 ) , on t h e o t h e r h a n d , f o u n d t h a t t h e s t u d e n t s ' o r i e n t a t i o n s t o a c t i v i t i e s o f t h e n u r s i n g r o l e c a n p e r s i s t u n c h a n g e d and e v e n d e v e l o p i n t h e d i r e c t i o n s i n i t i a t e d d u r i n g e d u c a t i o n , r e g a r d l e s s o f t h e t y p e o f work o r g a n i z a t i o n . Few s t u d i e s h a v e b e e n done on p r a c t i c i n g n u r s e s ' p e r c e p t i o n s o f t h e i r p r o f e s s i o n . O b v i o u s l y , when t h e s u b j e c t s o f t h e s t u d y a r e a l l n u r s i n g s t u d e n t s , e i t h e r u n d e r g r a d u a t e o r g r a d u a t e , f i n d i n g s a r e more l i k e l y t o i n d i c a t e p o s i t i v e p e r c e p t i o n s o f t h e p r o f e s s i o n s i n c e t h e s e s u b j e c t s a r e s t i l l i n f l u e n c e d by t h e i r e d u c a t i o n a l e n v i r o n m e n t . The n u r s e s who need t o be e x a m i n e d a r e t h o s e away f r o m t h e a c a d e m i c s e t t i n g and i n t h e w o r k p l a c e where t h e y a r e no l o n g e r i n f l u e n c e d by t h e i r e d u c a t i o n a l e n v i r o n m e n t , b u t a r e i n f l u e n c e d by many o t h e r v a r i a b l e s . I n s t r u m e n t s A f t e r e x a m i n i n g t h e l i t e r a t u r e , i t became e v i d e n t t h a t t h e r e were v e r y few a p p r o p r i a t e i n s t r u m e n t s a v a i l a b l e t o m e asure n u r s e s ' p e r c e p t i o n s o f t h e i r p r o f e s s i o n . R o t t k a m p ( 1 9 8 0 ) d e s i g n e d a q u e s t i o n n a i r e t o a s s e s s t h e e x t e n t t o w h i c h s t u d e n t n u r s e s a g r e e d o r d i s a g r e e d w i t h t h e d e f i n i t i o n o f p r o f e s s i o n a l n u r s i n g p r a c t i c e , t h e d e g r e e t o w h i c h c e r t a i n i d e n t i f i e d i m p e d i m e n t s r e a l l y e x i s t i n p r o f e s s i o n a l n u r s i n g p r a c t i c e , a nd t h e s o l u t i o n s f o r t h e s e i m p e d i m e n t s . The q u e s t i o n n a i r e a s k e d r e s p o n d e n t s t o c h o o s e a r e s p o n s e b e t w e e n a g r e e m e n t o r d i s a g r e e m e n t , r a t e e a c h o f t h e e l e v e n i t e m s a c c o r d i n g t o i m p o r t a n c e as an i m p e d i m e n t , and o u t l i n e s o l u t i o n s t o i m p e d i m e n t s o f most i m p o r t a n c e . D a v i s and O l e s e n (1964) l o o k e d a t c h a r a c t e r i s t i c s t h a t i n d i v i d u a l s f o u n d i m p o r t a n t t o b o t h t h e m s e l v e s and t h e i r p i c t u r e o f n u r s i n g , i n c l u d i n g s u c h t h i n g s as c l e a r l i n e s o f a u t h o r i t y , o r i g i n a l i t y , c r e a t i v i t y , h a r d w o r k , s k i l l , a nd c l e a r l y d e f i n e d work t a s k s . U s i n g a q u e s t i o n n a i r e e n t i t l e d Images o f N u r s i n g , t h e r e s p o n d e n t s were a s k e d t o c h e c k t h e l i s t e d c h a r a c t e r i s t i c s t h a t were v e r y i m p o r t a n t t o them. O t h e r r e s e a r c h e r s , s u c h a s K r amer ( 1 9 6 6 ) , h a y e o b t a i n e d i n f o r m a t i o n a b o u t n u r s e s * p e r c e p t i o n s o f t h e p r o f e s s i o n by i n t e r v i e w i n g s u b j e c t s . B e c a u s e t h e r e a r e few o b j e c t i v e i n s t r u m e n t s a v a i l a b l e t o s t u d y p e r c e p t i o n s o f t h e p r o f e s s i o n , V a l i g a ( 1 9 8 2 ) d e v e l o p e d t h e V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e . S i n c e V a l i g a ' s q u e s t i o n n a i r e was b a s e d on t h e c r i t e r i a o f a p r o f e s s i o n t h a t t h e i n v e s t i g a t o r a g r e e d w i t h , t h e i n v e s t i g a t o r c h o s e t o u s e i t . 24 CHAPTER I I I METHODOLOGY T h i s s t u d y was a d e s c r i p t i v e s u r v e y o f p e r c e p t i o n s o f t h e p r o f e s s i o n o f n u r s i n g h e l d by s t a f f n u r s e s . The m e t h o d o l o g y i n c l u d e d t h e use o f t h e V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e and a b a c k g r o u n d i n f o r m a t i o n q u e s t i o n n a i r e . These a r e d e s c r i b e d a s i s t h e s a m p l e and method o f d a t a c o l l e c t i o n . I n s t r u m e n t s V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e The V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e ( s e e A p p e n d i x A) was s e l e c t e d f o r measurement o f p e r c e p t i o n s o f t h e p r o f e s s i o n o f n u r s i n g . The q u e s t i o n n a i r e was d e v e l o p e d by V a l i g a i n 1982 and c o n s i s t s o f 25 s t a t e m e n t s t o w h i c h s u b j e c t s r e s p o n d by u s i n g a f i v e p o i n t s c a l e r a n g i n g f r o m s t r o n g l y a g r e e t o s t r o n g l y d i s a g r e e . A s c o r e o f +2 i s g i v e n f o r e a c h i t e m w i t h w h i c h t h e y S t r o n g l y A g r e e , a +1 f o r e a c h i t e m w i t h w h i c h t h e y A g r e e , a 0 f o r e a c h i t e m a b o u t w h i c h t h e y a r e U n s u r e , a -1 f o r e a c h i t e m w i t h w h i c h t h e y D i s a g r e e , and a -2 f o r e a c h i t e m w i t h w h i c h t h e y S t r o n g l y D i s a g r e e . The s c o r i n g scheme i s r e v e r s e d f o r t h o s e s t a t e m e n t s w h i c h a r e i n t e n d e d t o be " n e g a t i v e " ( I t e m s 9, 1 2 , 1 3 , 15 and 2 1 ) . The minimum p o s s i b l e s c o r e t h e n , i s -50 and t h e maximum s c o r e p o s s i b l e i s +50 ( p p . 1 3 1 - 1 3 2 ) . A c c o r d i n g t o V a l i g a ( 1 9 8 2 ) , " c o n t e n t v a l i d i t y was e s t a b l i s h e d t h r o u g h a p a n e l o f e x p e r t s " ( p . 1 2 5 ) . V a l i g a ( 1 9 8 2 ) s t a t e s t h a t : G e n e r a l l y , t h e e x p e r t s a g r e e d on t h e i r o v e r a l l r e s p o n s e s t o e a c h i t e m ; t h a t i s , 75% e i t h e r a g r e e d o r s t r o n g l y a g r e e d w i t h a s t a t e m e n t w h i c h was i n t e n d e d t o be a p o s i t i v e / d e s i r a b l e a c t i v i t y o f t h e p r o f e s s i o n a l n u r s e and 75% e i t h e r d i s a g r e e d o r s t r o n g l y d i s a g r e e d w i t h t h o s e s t a t e m e n t s w h i c h were i n t e n d e d t o be a n e g a t i v e / u n d e s i r a b l e a c t i v i t y o f t h e p r o f e s s i o n a l n u r s e ( p . 1 2 6 ) . I n a p i l o t s t u d y , c o n d u c t e d by V a l i g a , t h e c r i t e r i o n o f i n t e r n a l c o n s i s t e n c y was a p p l i e d t o t h e s c a l e by u s i n g t h e c o e f f i c i e n t a l p h a . B a s e d on t h e r e l i a b i l i t y c o e f f i c i e n t s , a l p h a was c o m puted t o be 0.86. The r e l i a b i l i t y o f e a c h i t e m was d e t e r m i n e d by c a l c u l a t i n g t h e c o r r e l a t i o n c o e f f i c i e n t o f e a c h s t a t e m e n t f o r t h e t o t a l p o p u l a t i o n ( V a l i g a , 1 9 8 2 ) . S i n c e V a l i g a ' s ( 1 9 8 2 ) s t u d y was d e s i g n e d t o d e s c r i b e c o g n i t i v e d e v e l o p m e n t and p e r c e p t i o n s a b o u t n u r s i n g a s a p r o f e s s i o n , t h e c h a n g e i n e a c h o f t h e s e v a r i a b l e s w h i c h o c c u r s o v e r t h e s p a n o f an a c a d e m i c y e a r , and t h e r e l a t i o n s h i p b e t w e e n t h e s e v a r i a b l e s f o r s t u d e n t s a t a l l f o u r l e v e l s o f b a c c a l a u r e a t e n u r s i n g p r o g r a m s , no d e s c r i p t i o n o f t h e m e a n i n g o f t h e s c o r e s was i n c l u d e d . The s c o r e s o b t a i n e d on t h e V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e were s i m p l y u s e d as a mode o f c o m p a r i s o n b o t h o v e r t i m e and b e t w e e n s t a g e s o f c o g n i t i v e d e v e l o p m e n t . S i n c e t h e p u r p o s e o f t h i s s t u d y i s t o d e t e r m i n e o n l y t h e c u r r e n t p e r c e p t i o n s o f t h e p r o f e s s i o n o f n u r s i n g h e l d by a l a r g e p o p u l a t i o n o f s t a f f n u r s e s i n r e l a t i o n t o a s p e c i f i e d g r o u p o f v a r i a b l e s , a method o f i n t e r p r e t i n g t h e s c o r e s was e s t a b l i s h e d . The m i d p o i n t o f s c o r e s r a n g i n g f r o m -50 t o +50 i s 0, s o 0 was d e f i n e d as t h e d i v i s i o n l i n e b e t w e e n a g r e e m e n t and l a c k o f a g r e e m e n t w i t h V a l i g a ' s d e f i n i t i o n o f t h e p r o f e s s i o n o f n u r s i n g , and +25 ( 7 5 % ) was d e f i n e d as t h e d i v i s i o n b e t w e e n a g r e e m e n t and a v e r y h i g h l e v e l o f a g r e e m e n t w i t h V a l i g a ' s d e f i n i t i o n . 27 B a c k g r o u n d I n f o r m a t i o n A q u e s t i o n n a i r e was d e s i g n e d by t h e i n v e s t i g a t o r t o c o l l e c t b a c k g r o u n d i n f o r m a t i o n a b o u t t h e s t a f f n u r s e s i n t h e s t u d y . The s u b j e c t s were a s k e d t o p r o v i d e t h e f o l l o w i n g i n f o r m a t i o n : a g e , p r e p a r a t o r y and a d d i t i o n a l e d u c a t i o n , t i m e w o r k e d s i n c e g r a d u a t i o n , l e n g t h o f t i m e w o r k e d i n p r e s e n t e m p l o y m e n t , and t y p e o f a g e n c y i n w h i c h p r e s e n t l y e m p l o y e d ( s e e A p p e n d i x B ) . Sample The p o p u l a t i o n f o r t h i s s t u d y c o n s i s t e d o f 12,913 s t a f f n u r s e s who were r e g i s t e r e d w i t h t h e R.N.A.B.C. on M a r c h 1, 1984. A random s a m p l e o f 600 was drawn f r o m t h i s p o p u l a t i o n . The R.N.A.B.C. s e n d s o u t y e a r l y r e g i s t r a t i o n f o r m s t o i t s members t h a t must be r e t u r n e d by March 1. The r e g i s t r a t i o n f o r m s r e q u i r e t h e n u r s e t o a n s w e r a v a r i e t y o f q u e s t i o n s , i n c l u d i n g s u c h t h i n g s as p l a c e o f emp l o y m e n t , p o s i t i o n i n t h e o r g a n i z a t i o n , and w h e t h e r employment i s on a c a s u a l , p a r t - t i m e , o r f u l l - t i m e b a s i s . S i n c e t h i s r e g i s t r a t i o n i n f o r m a t i o n i s s t o r e d i n a c o m p u t e r a t t h e R.N.A.B.C., i t was e a s i l y r e t r i e v e d t o e s t a b l i s h t h e s t u d y p o p u l a t i o n . 28 E t h i c s and Human R i g h t s Names o f s t a f f n u r s e s were r a n d o m l y s e l e c t e d by t h e c o m p u t e r a t t h e R.N.A.B.C. The p a r t i c i p a n t s ' a n o n y m i t y and c o n f i d e n t i a l i t y o f r e s p o n s e s was a s s u r e d i n t h a t an e m p l o y e e o f t h e R.N.A.B.C. s e n t o u t t h e c o d e d q u e s t i o n n a i r e s w i t h a l e t t e r ( s e e A p p e n d i x C) f r o m t h e i n v e s t i g a t o r s t a t i n g t h e p u r p o s e o f t h e r e s e a r c h and r e q u e s t i n g t h e s u b j e c t ' s p a r t i c i p a t i o n i n t h e s t u d y . The p a r t i c i p a n t ' s r e p l y i n d i c a t e d c o n s e n t . P r o c e d u r e F o r D a t a C o l l e c t i o n The 600 s e t s o f c o d e d q u e s t i o n n a i r e s t o g e t h e r w i t h t h e e x p l a n a t o r y l e t t e r and a d d r e s s e d , s t a m p e d e n v e l o p e s were m a i l e d by t h e 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 o f B r i t i s h C o l u m b i a i n e a r l y J a n u a r y , 1985. A f t e r a p e r i o d o f f o u r weeks had p a s s e d , 400 s e t s o f q u e s t i o n n a i r e s h a d n o t y e t been r e t u r n e d . A s e c o n d s e t o f q u e s t i o n n a i r e s t o g e t h e r w i t h t h e e x p l a n a t o r y l e t t e r and a d d r e s s e d , s t a m p e d e n v e l o p e s was t h e n s e n t by t h e R.N.A.B.C. t o t h e 400 s u b j e c t s who had not r e s p o n d e d . The s e c o n d m a i l i n g e l i c i t e d 136 added r e s p o n s e s m a k i n g a t o t a l o f 336, a r e t u r n r a t e o f 56%. Q u e s t i o n n a i r e s w e re c o d e d and s c o r e d and t h e d a t a were e n t e r e d i n t o c o m p u t e r f i l e s f o r t h e a n a l y s i s t o f o l l o w . 30 CHAPTER I V DATA ANALYSIS AND DISCUSSION OF FINDINGS I n t r o d u c t i o n The p u r p o s e s o f t h e s t u d y w e r e : 1) To d e t e r m i n e s t a f f n u r s e s ' p e r c e p t i o n s o f t h e p r o f e s s i o n o f n u r s i n g ; a n d (2) To d e t e r m i n e s t a f f n u r s e s ' p e r c e p t i o n s o f n u r s i n g i n r e l a t i o n t o t h e v a r i a b l e s o f a g e , p r e p a r a t o r y n u r s i n g e d u c a t i o n and a d d i t i o n a l p r e p a r a t i o n , number o f y e a r s w o r k e d s i n c e g r a d u a t i o n , l e n g t h o f t i m e i n p r e s e n t e m p l o y m e n t , and t y p e o f f a c i l i t y i n w h i c h p r e s e n t l y e m p l o y e d . P r e s e n t a t i o n o f t h e r e s u l t s o f t h e a n a l y s i s o f t h e b a c k g r o u n d i n f o r m a t i o n and r e s p o n s e s t o t h e V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e i s f o l l o w e d by a d i s c u s s i o n o f t h e f i n d i n g s . R e s p o n s e R a t e Of t h e 600 q u e s t i o n n a i r e s s e n t o u t , 336 ( 5 6 % ) w e r e r e t u r n e d . Of t h e s e , 74 ( 1 2 . 3 % ) were r e t u r n e d u n a n s w e r e d . A t o t a l o f 23 ( 3 . 8 % ) r e s p o n d e n t s i n d i c a t e d t h e y d i d n o t meet t h e c r i t e r i a b e c a u s e t h e y were no 31 l o n g e r e m p l o y e d f u l l - t i m e o r t h e y had b e e n p r o m o t e d . Q u e s t i o n n a i r e s r e t u r n e d w i t h o u t e x p l a n a t i o n s t o t a l l e d 51 ( 8 . 5 % ) . B a c k g r o u n d i n f o r m a t i o n q u e s t i o n n a i r e s w i t h two o r more q u e s t i o n s u n a n s w e r e d were o m i t t e d f r o m t h e a n a l y s i s . I f more t h a n f i v e r e s p o n s e s were o m i t t e d on t h e V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e , t h e q u e s t i o n n a i r e was e x c l u d e d f r o m t h e a n a l y s i s . T h u s , o f t h e t o t a l o f 600 q u e s t i o n n a i r e s m a i l e d o u t , 262 ( 4 4 . 6 % ) were p o t e n t i a l l y u s e f u l . A n a l y s i s o f B a c k g r o u n d I n f o r m a t i o n The b a c k g r o u n d i n f o r m a t i o n i n t h i s s t u d y was a n a l y z e d by c o m p u t e r , and t h e n , t o d e t e r m i n e how c l o s e l y t h e s a m p l e was r e p r e s e n t a t i v e o f t h e p o p u l a t i o n , w here p o s s i b l e and a p p r o p r i a t e , t h e s a m p l e was compared t o t h e p o p u l a t i o n o f s t a f f n u r s e s ( 1 2 , 6 2 0 ) e m p l o y e d i n B r i t i s h C o l u m b i a as d e s c r i b e d i n 1983 s t a t i s t i c s f r o m S t a t i s t i c s C a n ada (1984 s t a t i s t i c s were i n c o m p l e t e ) . A l t h o u g h t h e s a m p l e c o n s i s t e d o f 262 r e s p o n d e n t s , m i s s i n g d a t a have c a u s e d a d i f f e r e n t t o t a l number t o a p p e a r f o r some o f t h e v a r i a b l e s . Age The a g e s r e p r e s e n t e d i n t h e s a m p l e a r e s u m m a r i z e d i n T a b l e I as a r e c o r r e s p o n d i n g p e r c e n t a g e s f o r t h e p o p u l a t i o n . The r e s p o n d e n t s r a n g e d a n y w h e r e f r o m 21 t o 64 y e a r s o f age w i t h a mean o f 35.5 y e a r s . The m a j o r i t y o f r e s p o n d e n t s (65.4%) were i n t h e age g r o u p 25 t o 39. The p e r c e n t a g e d i s t r i b u t i o n s o f t h e r e s p o n d e n t s g e n e r a l l y m a t c h e d t h e d i s t r i b u t i o n s i n t h e p o p u l a t i o n . Any d i s c r e p a n c i e s n o t e d a r e m i n o r , i t c a n , t h e r e f o r e , be s a i d t h a t i n r e g a r d s t o a g e , t h e r e s p o n d e n t s a r e r e p r e s e n t a t i v e o f t h e p o p u l a t i o n o f s t a f f n u r s e s u n d e r s t u d y . N u r s i n g E d u c a t i o n The h i g h e s t l e v e l o f n u r s i n g e d u c a t i o n c o m p l e t e d by t h e r e s p o n d e n t s i s s u m m a r i z e d i n T a b l e I I a l o n g w i t h c o r r e s p o n d i n g p e r c e n t a g e s f o r t h e p o p u l a t i o n . E d u c a t i o n a l p r e p a r a t i o n o f r e s p o n d e n t s m a r k e d l y d i f f e r e d f r o m t h a t o f t h e p o p u l a t i o n . i n t h e p o p u l a t i o n t h e number o f n u r s e s w i t h a d i p l o m a i n n u r s i n g was 49.7%. The s a m p l e d e v i a t e d f r o m t h i s i n t h a t 213 (81.3%) o f t h e r e s p o n d e n t s h e l d a d i p l o m a i n n u r s i n g , w i t h 79 (30.2%) h a v i n g been p r e p a r e d i n 33 T a b l e I F r e q u e n c i e s by Age Sample P o p u l a t i o n Age Number P e r c e n t a g e P e r c e n t a g e 9 u n d e r 25 y r s . 17 6.6 8.7 25 - 29 y r s . 65 25.3 22.0 30 - 34 y r s . 54 21.0 19.4 35 - 39 y r s . 49 19.1 16.6 40 - 44 y r s . 26 10.1 12.8 45 - 49 y r s . 17 6.6 8.8 50 - 54 y r s . 18 7.0 6.3 55 y r s and o v e r 11 4.3 5.4 5 r e s p o n s e s m i s s i n g a S t a t i s t i c s Canada ( 1 9 8 3 ) c o m m u n i t y c o l l e g e p r o g r a m s , and 134 ( 5 1 . 1 % ) i n h o s p i t a l p r o g r a m s . On t h e o t h e r h a n d , 9.9% o f t h e p o p u l a t i o n had a b a c c a l a u r e a t e d e g r e e a s t h e i r h i g h e s t l e v e l o f p r e p a r a t i o n i n n u r s i n g e d u c a t i o n , b u t 37 ( 1 4 . 1 % ) o f t h e r e s p o n d e n t s had a b a c c a l a u r e a t e d e g r e e , 20 ( 7 . 6 % ) o f t h e s e b e i n g p o s t - b a s i c and 17 ( 6 . 5 % ) b e i n g g e n e r i c . The p e r c e n t a g e o f r e s p o n d e n t s who h e l d a m a s t e r ' s d e g r e e o r h i g h e r , h o w e v e r , was v e r y s i m i l a r t o t h a t i n t h e p o p u l a t i o n . S p e c i f i c a l l y , one ( 0 . 4 % ) o f t h e r e s p o n d e n t s and 0.1% o f t h e p o p u l a t i o n f e l l i n t o t h i s c a t e g o r y . Those r e s p o n d e n t s who were w o r k i n g t o w a r d o r had a l r e a d y o b t a i n e d e d u c a t i o n i n a r e a s o t h e r t h a n t h o s e s p e c i f i e d d i f f e r e d g r e a t l y f r o m t h e p o p u l a t i o n . Of t h e r e s p o n d e n t s , 11 ( 4 . 2 % ) f e l l i n t o t h i s c a t e g o r y w i t h 4 ( 1 . 5 % ) w i t h n u r s i n g a d m i n i s t r a t i o n c o u r s e s , 2 ( 0 . 8 % ) w i t h p o s t - b a s i c o p e r a t i n g room c o u r s e s , 3 ( 1 . 1 % ) w i t h p o s t - b a s i c p s y c h i a t r i c c o u r s e s , and 2 ( 0 . 8 % ) w i t h p o s t - b a s i c c r i t i c a l c a r e c o u r s e s . The p o p u l a t i o n d i f f e r e d s i g n i f i c a n t l y i n t h a t 4 0 . 3 % had a t t a i n e d a p o s t - b a s i c d i p l o m a / c e r t i f i c a t e . I n a l l c a s e s , t h e s a m p l e was n o t r e p r e s e n t a t i v e o f t h e p o p u l a t i o n i n t e r m s o f e d u c a t i o n a l p r e p a r a t i o n . 35 T a b l e I I F r e q u e n c i e s by H i g h e s t N u r s i n g E d u c a t i o n A t t a i n e d N u r s i n g E d u c a t i o n Sample Number P e r c e n t a g e P o p u l a t i o n P e r c e n t a g e 3 D i p l o m a (1) Community C o l l e g e 79 (2) H o s p i t a l B a s e d 134 P o s t - b a s i c B a c c a l a u r e a t e 20 G e n er i c B a c c a l a u r e a t e 17 M a s t e r ' s o r H i g h e r 1 O t h e r ( p o s t -b a s i c d i p l o m a / c e r t i f i c a t e ) : N u r s i n g A d m i n i s t r a t i o n 4 P o s t - b a s i c O.R. 2 P o s t - b a s i c P s y c h i a t r i c 3 P o s t - b a s i c C r i t i c a l C a r e 2 30 .2 51.1 7.6 6.5 0.4 1.5 0.8 1.1 0.8 c o m b i n e d 49. 7 c o m b i n e d 9.9 0.1 40.3 a S t a t i s t i c s Canada ( 1 9 8 3 ) 36 Number o f Y e a r s Worked S i n c e G r a d u a t i o n R e p o r t s o f t h e number o f y e a r s w o r k e d s i n c e g r a d u a t i o n a r e p r e s e n t e d i n T a b l e I I I . The number o f y e a r s t h a t t h e r e s p o n d e n t s had w o r k e d s i n c e g r a d u a t i o n r a n g e d f r o m a minimum o f 0.5 y e a r s t o a maximum o f 37 y e a r s , w i t h a mean o f 11.2 y e a r s . A t o t a l o f 199 ( 7 6 . 2 % ) r e s p o n d e n t s h ad w o r k e d 15 y e a r s o r l e s s s i n c e g r a d u a t i o n . T a b l e I I I F r e q u e n c i e s by Number o f Y e a r s Worked S i n c e G r a d u a t i o n Number o f Y e a r s Worked S i n c e G r a d u a t i o n Number P e r c e n t a g e . 5 y r s . - 5 y r s . 6 y r s . - 10 y r s . 11 y r s . - 15 y r s . 16 y r s . - 20 y r s . 21 y r s . - 25 y r s . 26 y r s . - 30 y r s . 31 y r s . and more one r e s p o n s e m i s s i n g 64 24.5 82 31.4 53 20.3 29 11.1 17 6.5 14 5.4 2 0.8 37 L e n g t h o f Time i n P r e s e n t Employment A summary o f t h e r e s p o n d e n t s ' r e p o r t s o f l e n g t h o f t i m e i n c u r r e n t p l a c e o f employment a r e shown i n T a b l e I V . Of t h e 261 r e s p o n d e n t s , t h e m a j o r i t y ( 6 2 . 1 % ) had w o r k e d t h r e e o r more y e a r s i n t h e i r c u r r e n t j o b s . T a b l e I V F r e q u e n c i e s by L e n g t h o f Time i n P r e s e n t Employment L e n g t h o f Time I n P r e s e n t Employment Number P e r c e n t a g e 6 mos. - 1 y r . 20 7.7 1 y r . - 3 y r s . 79 30.2 3 y r s . - 5 y r s . 67 25.7 more t h a n 5 y r s . 95 36.4 one r e s p o n s e m i s s i n g A g e n c y o f Employment The b a c k g r o u n d i n f o r m a t i o n i n d i c a t i n g t h e a g e n c i e s i n w h i c h t h e r e s p o n d e n t s were c u r r e n t l y e m p l o y e d i s s u m m a r i z e d i n T a b l e V C o r r e s p o n d i n g 38 p e r c e n t a g e s f o r t h e p o p u l a t i o n a r e a l s o i n c l u d e d , T a b l e V F r e q u e n c i e s by A g e n c y o f Employment A g e n c y o f Employment Sample Number P e r c e n t a g e P o p u l a t i o n P e r c e n t a g e 9 A c u t e C a r e Hosp. 236 A c t i v a t i o n / R e h a b . H o s p i t a l 2 P s y c h i a t r i c Hosp. 7 90.0 0.8 2.6 83.6 H o s p i t a l s c o m b i n e d L o n g Term C a r e F a c i l i t y P e r s o n a l C a r e I n t e r m e d i a t e C a r e E x t e n d e d C a r e N u r s i n g Home 12 0 0.8 0.4 4.6 0.0 F a c i l i t i e s c o m b i n e d 2.9 O t h e r : P s y c h o g e r i a t r i c F a c i l i t i e s 0.8 13.5 a S t a t i s t i c s Canada (1983) 39 The m a j o r i t y o f t h e r e s p o n d e n t s (90%) w o r k e d i n h o s p i t a l s , as do t h e m a j o r i t y (83.6%) o f t h e p o p u l a t i o n . O n l y 2 (0.8%) o f t h e r e s p o n d e n t s w o r k e d i n f a c i l i t i e s o t h e r t h a n t h o s e s p e c i f i e d . B o t h o f t h e s e r e s p o n d e n t s w o r k e d i n p s y c h o g e r i a t r i c f a c i l i t i e s . I n summary, t h e s a m p l e c o n s i s t e d o f s t a f f n u r s e s r a n g i n g i n age f r o m 21 t o 64 y e a r s , t h e m a j o r i t y (81.3%) o f whom h e l d a d i p l o m a i n n u r s i n g , and h a d w o r k e d a n y w h e r e f r o m 0.5 y e a r s t o 37 y e a r s s i n c e g r a d u a t i o n . The m a j o r i t y o f t h e s a m p l e (62.1%) h a d wo r k e d 3 o r more y e a r s i n t h e i r c u r r e n t j o b and 90% o f th e r e s p o n d e n t s w o r k e d i n a c u t e c a r e h o s p i t a l s . G e n e r a l l y s p e a k i n g , t h e s a m p l e d e v i a t e d f r o m t h e p o p u l a t i o n i n a l l a r e a s o f c o m p a r i s o n , e x c e p t f o r t h e i r a g e s . S c o r i n g o f t h e V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e i n c o m p l e t i n g t h e V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e , r e s p o n d e n t s i n d i c a t e d w h e t h e r t h e y S t r o n g l y A g r e e d ( S A ) , A g r e e d ( A ) , were U n d e c i d e d o r U n s u r e ( U ) , D i s a g r e e d ( D ) , o r S t r o n g l y D i s a g r e e d (SD) w i t h e a c h s t a t e m e n t . A s c o r e o f +2 was a s s i g n e d t o t h e S t r o n g l y A g r e e c a t e g o r y , a +1 t o t h e A g r e e c a t e g o r y , a 0 t o t h e U n s u r e c a t e g o r y , and a -1 and a -2 t o t h e D i s a g r e e and S t r o n g l y D i s a g r e e c a t e g o r i e s r e s p e c t i v e l y . S c o r i n g was r e v e r s e d f o r s t a t e m e n t s 9, 12, 1 3 , 1 5 , and 2 1 , s i n c e t h e y were i n t e n d e d t o be " n e g a t i v e . " T h i s r e s u l t e d i n a p o s s i b l e r a n g e f r o m -50 t o +50. A 0 was a s s i g n e d t o s t a t e m e n t s f o r w h i c h no r e s p o n s e was g i v e n . A t o t a l o f 33 s t a t e m e n t s on 23 i n s t r u m e n t s f e l l i n t o t h i s c a t e g o r y . No r e s p o n d e n t o m i t t e d r e s p o n s e s t o more t h a n 3 s t a t e m e n t s . I t e m a n a l y s i s o f r e s p o n s e s i n d i c a t e d t h a t t h e m i s s i n g r e s p o n s e s were g e n e r a l l y f o r d i f f e r e n t i t e m s . R e l i a b i l i t y o f t h e v i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e I n s e l e c t i n g V a l i g a ' s ( 1 9 8 2 ) V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e i t was r e c o g n i z e d t h a t t h e i n s t r u m e n t had b e en u s e d o n l y o n c e . V a l i g a ( 1 9 8 2 ) a n a l y z e d f o r i n t e r n a l c o n s i s t e n c y t o d e t e r m i n e r e l i a b i l i t y a t t h e t i m e o f c o n s t r u c t i o n o f t h e i n s t r u m e n t , a n d , b a s e d on t h e r e l i a b i l i t y c o e f f i c i e n t s o f a l l o f t h e i t e m s , c omputed a l p h a t o be 0.86 ( p . 1 4 0 ) . P o l i t and H u n g l e r ( 1 9 8 3 ) d i s c u s s v a r i o u s methods u s e d t o d e t e r m i n e i n s t r u m e n t r e l i a b i l i t y and d e s c r i b e t h e c o e f f i c i e n t a l p h a as " p e r h a p s t h e s i n g l e most u s e f u l i n d e x o f r e l i a b i l i t y a v a i l a b l e " ( p . 3 9 1 ) . U s i n g C r o n b a c h ' s a l p h a t o d e t e r m i n e t h e r e l i a b i l i t y o f t h e V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e w i t h t h i s s a m p l e r e s u l t e d i n a c o e f f i c i e n t a l p h a o f 0.73. P o l i t a n d H u n g l e r ( 1 9 8 3 ) recommend a c o e f f i c i e n t o f 0.60 t o 0.70 as s u f f i c i e n t f o r g r o u p l e v e l c o m p a r i s o n s ( p . 3 9 3 ) . The c o e f f i c i e n t a l p h a f o r t h i s s a m p l e i s , t h e r e f o r e , w i t h i n t h e a c c e p t a b l e r a n g e . V i e w s A b o u t N u r s i n g The v i e w s a b o u t n u r s i n g e l i c i t e d f r o m t h e s t a f f n u r s e s were d e t e r m i n e d by a d d i n g t h e s c o r e s on e a c h q u e s t i o n n a i r e . The s c o r e s f o r t h e s a m p l e a r e s u m m a r i z e d i n T a b l e V I . The f i n d i n g s i n d i c a t e t h a t t h e minimum s c o r e o b t a i n e d was 0 and t h e maximum was 45, w i t h a mean o f 23. A l l r e s p o n d e n t s v i e w e d n u r s i n g a s m e e t i n g V a l i g a ' s p r o f e s s i o n a l c r i t e r i a a n d 94 ( 3 5 . 9 % ) a g r e e d v e r y s t r o n g l y w i t h h e r d e f i n i t i o n , r e c e i v i n g s c o r e s a b o v e 25 ( 7 5 % ) . 42 Table VI F r e q u e n c i e s By Scores On Views About N u r s i n g  Q u e s t i o n n a i r e S c o re (-50 - +50) Number Per c e n t a g e -50 t o -1 0 0.0 0 - 5 5 1 . 9 6 - 10 6 2.3 11 -- 15 37 14.1 16 -- 20 53 20.2 21 -- 25 67 25.6 26 -- 30 48 18.3 31 -- 35 35 13.4 36 -- 40 7 2.7 41 -- 45 4 1.5 A n a l y s i s of V a r i a b l e s i n R e l a t i o n to Scores In d e t e r m i n i n g i f , i n f a c t , the s p e c i f i e d v a r i a b l e s of age, e d u c a t i o n , y e a r s worked s i n c e g r a d u a t i o n , l e n g t h of time i n p r e s e n t employment, and the agency of employment, had any r e l a t i o n s h i p to the s c o r e s o b t a i n e d on the Views About N u r s i n g Q u e s t i o n n a i r e , a v a r i e t y of s t a t i s t i c a l analyses were performed. A l l r e s u l t s were t e s t e d at a .05 l e v e l of s i g n i f i c a n c e . Age In determining the r e l a t i o n s h i p between the age of the respondents and the scores obtained, a Pearson product-moment c o r r e l a t i o n was used. With a sample of 257, a c o e f f i c i e n t of -.0621 with a P = .161 was obtained. Nursing Education For the purpose of a n a l y z i n g the r e l a t i o n s h i p between l e v e l of education and the scores on the Views About Nursing Q u e s t i o n n a i r e , the sample was d i v i d e d i n t o three groups i n s t e a d of s i x , s i n c e there were so few respondents who had any more than a diploma i n n u r s i n g . The three groups c o n s i s t e d of those respondents who h e l d a diploma from a community c o l l e g e , those who h e l d a diploma from a h o s p i t a l program, and those who h e l d any education beyond that of a b a s i c nursing diploma. The scores of the respondents of the three d i f f e r e n t groups were t e s t e d with a 3 x 1 ANOVA design. The f i n d i n g s of an F = 1.291 and P = 0.277, i n d i c a t e that l e v e l of education i s not s i g n i f i c a n t l y r e l a t e d to the scores obtained on the q u e s t i o n n a i r e s . The f i n d i n g s may, however, be m i s l e a d i n g s i n c e the group of nurses with any advanced e d u c a t i o n a l p r e p a r a t i o n i n n u r s i n g was 49 (18.7%) and i n c l u d e d a l l types of advanced p r e p a r a t i o n such as a b a c c a l a u r e a t e or master's degree, as w e l l as p o s t - b a s i c p r e p a r a t i o n i n c l i n i c a l s p e c i a l t y areas. No d i s t i n c t i o n was made between advanced academic p r e p a r a t i o n and p o s t - b a s i c c l i n i c a l courses. To determine i f master's p r e p a r a t i o n develops p r o f e s s i o n a l a t t i t u d e s more c o n s i s t e n t with V a l i g a ' s , f u r t h e r study i s needed. The i n f o r m a t i o n p u b l i s h e d by S t a t i s t i c s Canada (1983) i n d i c a t e s that there are p r o p o r t i o n a t e l y more s t a f f nurses i n t h i s study who have b a c c a l a u r e a t e p r e p a r a t i o n i n n u r s i n g than there are i n the p o p u l a t i o n . The sample had 14.5% (38), compared to the p o p u l a t i o n , which has 10%. Number of Years Worked Since Graduation In determining the r e l a t i o n s h i p between the number of years worked s i n c e graduation and the scores obtained on the Views About Nursing Q u e s t i o n n a i r e , a 45 P e a r s o n p r o d u c t - m o m e n t c o r r e l a t i o n was u s e d . W i t h a s a m p l e o f 261, a c o e f f i c i e n t o f -.0591 w i t h a P = .171 was o b t a i n e d . The f i n d i n g s s u g g e s t t h a t t h e r e i s an i n v e r s e r e l a t i o n s h i p b e t w e e n t h e s c o r e s and t h e number o f y e a r s w o r k e d s i n c e g r a d u a t i o n , i n d i c a t i n g t h a t as t h e number o f y e a r s i n c r e a s e s , t h e s c o r e d e c r e a s e s . The r e s u l t s a r e , h o w e v e r , n o t s t a t i s t i c a l l y s i g n i f i c a n t . L e n g t h o f Time i n P r e s e n t Employment F o r t h e p u r p o s e o f a n a l y z i n g t h e r e l a t i o n s h i p b e t w e e n t h e l e n g t h o f t i m e i n p r e s e n t a r e a o f employment and t h e s c o r e s o b t a i n e d on t h e V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e , t h e s c o r e s o f t h e r e s p o n d e n t s o f t h e f o u r d i f f e r e n t g r o u p s were t e s t e d u s i n g a 4 x 1 ANOVA d e s i g n . An F = 0.817 w i t h a P = 0.486, i n d i c a t e t h e l e n g t h o f t i m e i n t h e c u r r e n t a r e a o f employment i s no t s i g n i f i c a n t l y r e l a t e d t o t h e s c o r e s o b t a i n e d on t h e q u e s t i o n n a i r e . A g e n c y o f Employment I n d e t e r m i n i n g t h e r e l a t i o n s h i p b e t w e e n t h e a g e n c y i n w h i c h t h e r e p o n d e n t s were c u r r e n t l y e m p l o y e d and t h e s c o r e s o b t a i n e d on t h e V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e , t h e s a m p l e was d i v i d e d i n t o two g r o u p s , n a m e l y , t h o s e who w o r k e d i n a c u t e c a r e h o s p i t a l s and t h o s e who w o r k e d i n any o f t h e o t h e r a g e n c i e s s p e c i f i e d . The d i v i s i o n was n e c e s s a r y s i m p l y b e c a u s e t h o s e n u r s e s t h a t w o r k e d i n a c u t e c a r e h o s p i t a l s made up t h e m a j o r i t y (236 o r 90%) o f t h e s a m p l e , l e a v i n g o n l y 26 ( 1 0 % ) i n t h e s e c o n d g r o u p . R e s u l t s o b t a i n e d by any s t a t i s t i c a l means w o u l d be m i s l e a d i n g , t h e r e f o r e , no s t a t i s t i c a l t e s t s were p e r f o r m e d on t h i s v a r i a b l e . I n summary, t h e s t u d y i n d i c a t e s t h a t a l l 262 r e s p o n d e n t s s u p p o r t V a l i g a ' s d e f i n i t i o n o f a p r o f e s s i o n . The s t u d y a l s o s u g g e s t s t h a t as age and number o f y e a r s w o r k e d s i n c e g r a d u a t i o n i n c r e a s e t h e s c o r e s d e c r e a s e , a l t h o u g h t h e f i n d i n g s a r e n o t s t a t i s t i c a l l y s i g n i f i c a n t . The f i n d i n g s a l s o d e m o n s t r a t e no r e l a t i o n s h i p b e t w e e n e d u c a t i o n and t h e s c o r e s , o r b e t w e e n t h e l e n g t h o f t i m e i n t h e i r c u r r e n t p l a c e o f employment and t h e s c o r e s . Due t o t h e f a c t t h a t s u c h a l a r g e m a j o r i t y o f t h e s a m p l e w o r k e d i n a c u t e c a r e h o s p i t a l s , no s t a t i s t i c a l t e s t s were p e r f o r m e d on t h e d i f f e r e n c e b e t w e e n t h e two g r o u p s . D i s c u s s i o n I n c o m p a r i n g t h e s c o r e s o b t a i n e d by t h e r e s p o n d e n t s on t h e V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e , w i t h t h e p o s t - t e s t s c o r e s o b t a i n e d by t h e s t u d e n t s i n V a l i g a ' s ( 1 9 8 2 ) s t u d y , i t was f o u n d t h a t t h e y were v e r y s i m i l a r . The s c o r e s i n V a l i g a ' s s t u d y r a n g e d f r o m 10 t o 38 f o r f r e s h m a n s t u d e n t s , f r o m 14 t o 40 f o r sophomore s t u d e n t s , f r o m 10 t o 42 f o r j u n i o r s t u d e n t s , and 14 t o 42 f o r s e n i o r s t u d e n t s ( p . 1 5 3 ) . A l t h o u g h t h e s c o r e s o f t h e r e s p o n d e n t s went as l o w a s 0, o n l y 11 ( 4 . 2 % ) o b t a i n e d s c o r e s b e t w e e n 0 and 10, i n d i c a t i n g t h a t b o t h t h e s t u d e n t s and t h e r e s p o n d e n t s s c o r e d a t o r a b o v e t h e m i d p o i n t , w h i c h was d e f i n e d as 0. A f t e r e x a m i n i n g t h e r e l a t i o n s h i p o f t h e s p e c i f i e d v a r i a b l e s t o t h e s c o r e s o b t a i n e d on t h e V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e , s e v e r a l p o s s i b l e e x p l a n a t i o n s a r i s e , as do o t h e r q u e s t i o n s . F i r s t , a l t h o u g h t h e f i n d i n g s a r e n o t s t a t i s t i c a l l y s i g n i f i c a n t , t h e y s u g g e s t t h a t t h e r e i s an i n v e r s e r e l a t i o n s h i p b e t w e e n t h e s c o r e s and a g e , i n d i c a t i n g t h a t as t h e age i n c r e a s e s , t h e s c o r e s d e c r e a s e . The l o w e r s c o r e s mean t h a t p e r c e p t i o n s o f t h e p r o f e s s i o n a r e l e s s c o n g r u e n t w i t h V a l i g a ' s v i e w s t h a n a r e t h e p e r c e p t i o n s o f t h o s e who r e c e i v e d h i g h s c o r e s . O l d e r n u r s e s a r e more l i k e l y t o h a v e been e d u c a t e d i n p r o g r a m s t h a t r e f l e c t e d t h e t r a d i t i o n a l a t t i t u d e s o f s u b s e r v i e n c e , o b e d i e n c e and d e v o t i o n ( G r e i n e r , 1 9 8 1 ) . Some o f t h e c o n c e p t s i n c l u d e d i n V a l i g a ' s q u e s t i o n n a i r e may be new and somewhat d i f f i c u l t t o a s s i m i l a t e . The i d e a o f m a k i n g t h e i r own d e c i s i o n s and b e i n g r e s p o n s i b l e , a c c o u n t a b l e and i n d e p e n d e n t must be v e r y d i f f i c u l t , a f t e r b e i n g s o c i a l i z e d i n t o t h i n k i n g t h a t o n l y p h y s i c i a n s b e h a v e i n t h i s manner, and t h a t n u r s e s s i m p l y f u n c t i o n as h a n d m a i d e n s t o them. A l t h o u g h few s t u d i e s h a v e e x a m i n e d age as a v a r i a b l e w h i c h may i n f l u e n c e n u r s e s ' p e r c e p t i o n s o f t h e p r o f e s s i o n , t h e f i n d i n g s were o p p o s i t e t o t h o s e s u g g e s t e d i n t h i s s t u d y . F o r e x a m p l e , K e r g i n ( 1 9 6 8) f o u n d t h a t as age i n c r e a s e d so d i d o c c u p a t i o n a l c ommitment, a n d , a l t h o u g h T e t r e a u l t ' s ( 1 9 7 6 ) s t u d y i n v o l v e d s t u d e n t s , she f o u n d t h a t o l d e r s t u d e n t s had more p o s i t i v e a t t i t u d e s t o w a r d s n u r s i n g t h a n d i d y o u n g e r o n e s . S i n c e t h e V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e was d e s i g n e d and u s e d w i t h s t u d e n t s who were f a m i l i a r w i t h c u r r e n t t e r m s s u c h as n u r s i n g d i a g n o s i s , n u r s i n g t h e o r y and e v a l u a t i n g n u r s i n g c a r e , o l d e r n u r s e s may be l e s s f a m i l i a r w i t h them, and p e r h a p s r e w o r d i n g o f t h e s t a t e m e n t s i n t h e q u e s t i o n n a i r e w o u l d h e l p c l a r i f y t e r m i n o l o g y . S e c o n d , a v a r i a b l e c l o s e l y r e l a t e d t o a g e , and w i t h s i m i l a r r e s u l t s i n r e l a t i o n t o t h e s c o r e o b t a i n e d on t h e q u e s t i o n n a i r e , was t h a t o f t h e number o f y e a r s w o r k e d s i n c e g r a d u a t i o n . A l t h o u g h t h e r e s u l t s a r e n o t s t a t i s t i c a l l y s i g n i f i c a n t , t h e y do s u g g e s t an i n v e r s e r e l a t i o n s h i p b e t w e e n t h e number o f y e a r s w o r k e d and t h e s c o r e s , i n d i c a t i n g t h a t t h e l o n g e r n u r s e s w o r k e d , t h e l o w e r t h e i r s c o r e s w e r e . The l o w e r s c o r e s mean t h a t t h e i r p e r c e p t i o n s a r e l e s s c o n s i s t e n t w i t h V a l i g a ' s p r o f e s s i o n a l v i e w s t h a n a r e t h o s e o f r e s p o n d e n t s w i t h h i g h s c o r e s . A g a i n , t h e more y e a r s t h a t n u r s e s h a v e w o r k e d , t h e o l d e r t h e y a r e , and t h e more l i k e l y t h a t t h e i r e d u c a t i o n a l p r e p a r a t i o n e m p h a s i z e d t r a d i t i o n a l v a l u e s and a t t i t u d e s t o w a r d t h e p r o f e s s i o n o f n u r s i n g . Those n u r s e s , on t h e o t h e r h a n d , who g r a d u a t e d many y e a r s a g o , b u t t h e n t o o k t i m e o u t t o be homemakers f o r some y e a r s b e f o r e r e t u r n i n g t o p r a c t i c e , h a v e e s s e n t i a l l y o n l y w o r k e d f o r s h o r t p e r i o d s o f t i m e . P e r h a p s e x p o s u r e t o t h e new t r e n d s i n n u r s i n g t h a t n u r s e s w o u l d r e c e i v e i n r e f r e s h e r p r o g r a m s w o u l d make them more r e c e p t i v e t o t h e c h a n g i n g a t t i t u d e s i n 50 n u r s i n g t h a n t h e i r c o u n t e r p a r t s , who g r a d u a t e d many y e a r s ago w i t h t r a d i t i o n a l v i e w s and t h e n became e m p l o y e d i n and s t a y e d e m p l o y e d i n o r g a n i z a t i o n s t h a t may h a v e h e l d t o more t r a d i t i o n a l v i e w s o f n u r s i n g o v e r t h e y e a r s . T h i r d , i n an a t t e m p t t o i n c r e a s e i t s p r o f e s s i o n a l s t a t u s , n u r s i n g h a s l e a n e d h e a v i l y on e d u c a t i o n , b e l i e v i n g t h a t h i g h e r l e v e l s o f n u r s i n g e d u c a t i o n d e v e l o p a t t i t u d e s t o t h e p r o f e s s i o n o f n u r s i n g t h a t a r e c o n g r u e n t w i t h t h o s e i d e n t i f i e d by V a l i g a . The f i n d i n g s i n t h i s s t u d y , h o w e v e r , s u g g e s t t h a t t h e r e i s no s i g n i f i c a n t r e l a t i o n s h i p b e t w e e n l e v e l o f e d u c a t i o n and t h e s c o r e s o b t a i n e d on t h e q u e s t i o n n a i r e . P o s s i b l e e x p l a n a t i o n s f o r t h e s e f i n d i n g s may i n c l u d e t h e f a c t t h a t t h e m a j o r i t y ( 8 1 . 3 % ) o f t h e p o p u l a t i o n had a s i m i l a r n u r s i n g e d u c a t i o n , n a m e l y a d i p l o m a . One m i g h t e x p e c t n u r s e s w i t h s i m i l a r e d u c a t i o n t o h a v e s i m i l a r p e r c e p t i o n s o f t h e p r o f e s s i o n . To d e t e r m i n e i f , i n f a c t , e d u c a t i o n d o e s make a d i f f e r e n c e i n t h e p e r c e p t i o n s o f n u r s e s , a l o n g i t u d i n a l s t u d y s h o u l d be c a r r i e d o u t , p e r i o d i c a l l y e x a m i n i n g s t u d e n t s ' p e r c e p t i o n s o f t h e p r o f e s s i o n t h r o u g h o u t d i p l o m a a n d b a c c a l a u r e a t e p r o g r a m s , and t h e n a f t e r some t i m e i n p r a c t i c e . P e r h a p s i t i s n o t so much e d u c a t i o n , b u t v a r i a b l e s i n t h e work e n v i r o n m e n t t h a t a r e r e s p o n s i b l e f o r f o r m i n g l a s t i n g p e r c e p t i o n s . A l t h o u g h few l o n g i t u d i n a l s t u d i e s h a v e b e e n d o n e , C o r w i n & T a v e s (1962) f o u n d t h a t b a c c a l a u r e a t e - p r e p a r e d n u r s e s c o n t i n u e d t o v a l u e t h e p r o f e s s i o n a l r o l e c o n c e p t i o n h i g h l y a f t e r g r a d u a t i o n , i n s p i t e o f t h e l a c k o f o p p o r t u n i t y t o f u l f i l i t . They f o u n d t h i s t o be l e s s t r u e o f d i p l o m a - p r e p a r e d n u r s e s . F o u r t h , a l t h o u g h t h e l i t e r a t u r e i s l i m i t e d , i t d o e s s u g g e s t t h a t t h e l e n g t h o f t i m e i n t h e c u r r e n t a r e a o f employment i n f l u e n c e s n u r s e s ' p e r c e p t i o n s o f t h e p r o f e s s i o n . The r e s u l t s o f t h i s s t u d y do n o t s u p p o r t t h i s b e l i e f , as t h e f i n d i n g s i n d i c a t e t h a t t h e r e i s no r e l a t i o n s h i p b e t w e e n t h e t i m e i n t h e c u r r e n t a r e a o f employment and t h e s c o r e s o b t a i n e d on t h e q u e s t i o n n a i r e . A g a i n , s i n c e t h e q u e s t i o n n a i r e h a s o n l y b een u s e d once b e f o r e w i t h s t u d e n t s who were f a m i l i a r w i t h t h e t e r m s u t i l i z e d , maybe t h e r e were some d i f f e r e n c e s o f i n t e r p r e t a t i o n i n t h e s t a t e m e n t s on t h e q u e s t i o n n a i r e . To t r u l y f i n d t h e i n f l u e n c e t h a t t i m e i n an a r e a o f employment h a s on n u r s e s ' p e r c e p t i o n s , a l o n g i t u d i n a l s t u d y s h o u l d be c a r r i e d o u t i n w h i c h n u r s e s ' p e r c e p t i o n s a r e e x a m i n e d , b e g i n n i n g i n t h e a c a d e m i c s e t t i n g and t h e n e v e r y s e v e r a l y e a r s i n p r a c t i c e . I n a l o n g i t u d i n a l s t u d y c a r r i e d o u t by Kramer ( 1 9 6 6 , 1 9 6 9 ) , i t was e v i d e n t t h a t a f t e r two y e a r s o f c o n t i n u e d e m p l o y m e n t , n u r s e s who i n i t i a l l y h e l d h i g h p r o f e s s i o n a l r o l e c o n c e p t i o n s showed a s i g n i f i c a n t d e c l i n e i n t h e s e a r e a s . A r e t h e s e c h a n g e s due t o b u r e a u c r a t i c p r a c t i c e s , as Kramer s u g g e s t s , o r a r e t h e y due t o some o t h e r v a r i a b l e s ? F i n a l l y , s i n c e a l a r g e m a j o r i t y o f t h e r e s p o n d e n t s w o r k e d i n a c u t e c a r e f a c i l i t i e s , a n y s t a t i s t i c a l a n a l y s e s i n r e l a t i o n t o t h e a g e n c y o f employment and t h e s c o r e s o b t a i n e d on t h e q u e s t i o n n a i r e , w o u l d be i n a p p r o p r i a t e . A l t h o u g h t h e l i t e r a t u r e i s l i m i t e d , t h e f i n d i n g s a r e c o n f l i c t i n g . Some ( K r a m e r , 1970, Q u i n t , 1967) l i t e r a t u r e s u g g e s t s t h a t t h e a g e n c y o f employment makes a l a r g e i m p a c t on n u r s e s * p r o f e s s i o n a l p e r c e p t i o n s , w h i l e o t h e r ( S i m p s o n , 1979) f i n d i n g s s u g g e s t t h a t i t d o e s n o t . C o m p a r i n g t h e p e r c e p t i o n s o f t h e n u r s e s w o r k i n g i n d i f f e r e n t t y p e s o f i n s t i t u t i o n s c o u l d p r o v i d e u s e f u l i n f o r m a t i o n f o r b o t h n u r s i n g e d u c a t o r s and a d m i n i s t r a t o r s . S i n c e a c u t e c a r e f a c i l i t i e s a r e g e n e r a l l y more i n f l u e n c e d by m e d i c i n e t h a n some o f t h e o t h e r s , i t w o u l d be i n t e r e s t i n g t o d e t e r m i n e i f n u r s e s ' p r o f e s s i o n a l p e r c e p t i o n s a r e d i f f e r e n t i n t h o s e f a c i l i t i e s . S i n c e a l l t y p e s o f f a c i l i t i e s a r e u s e d i n t h e e d u c a t i o n o f s t u d e n t s , t h e i d e n t i f i c a t i o n o f e n v i r o n m e n t a l i n f l u e n c e s on t h e i r p r o f e s s i o n a l a t t i t u d e s and b e h a v i o r w o u l d be u s e f u l . The f i n d i n g s m i g h t s u g g e s t d i r e c t i o n f o r e d u c a t o r s , i n t h a t s t u d e n t s need t o be made aware o f some o f t h e e n v i r o n m e n t a l i n f l u e n c e s and t a u g h t a p p r o p r i a t e methods o f c o p i n g w i t h them. A w a r e n e s s o f e n v i r o n m e n t a l i n f l u e n c e s on p r o f e s s i o n a l a t t i t u d e s and b e h a v i o r may g i v e d i r e c t i o n t o n u r s e a d m i n i s t r a t o r s i n h e l p i n g them p r o v i d e work e n v i r o n m e n t s t h a t p e r m i t n u r s e s t o d e v e l o p p r o f e s s i o n a l a t t i t u d e s c o n g r u e n t w i t h t h o s e s e t f o r t h by V a l i g a . I n summary, t h e f i n d i n g s s t r o n g l y s u g g e s t t h e need f o r a l o n g i t u d i n a l s t u d y , b e g i n n i n g i n t h e e d u c a t i o n a l s e t t i n g and c o n t i n u i n g o v e r t i m e i n p r a c t i c e s e t t i n g s , t o compare s t u d e n t s and g r a d u a t e s f r o m d i f f e r e n t t y p e s o f e d u c a t i o n a l p r o g r a m s . A f u r t h e r s t u d y t o d e m o n s t r a t e e n v i r o n m e n t a l i n f l u e n c e s on p r o f e s s i o n a l a t t i t u d e s and b e h a v i o r s h o u l d a l s o be c a r r i e d o u t . S i n c e t h e V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e h a s n o t had w i d e u s a g e i n r e s e a r c h , f u r t h e r s t u d i e s s h o u l d be done u t i l i z i n g i t , t o e n s u r e r e l i a b l e u s e w i t h n u r s e s i n a l l a r e a s o f t h e p r o f e s s i o n . 54 CHAPTER V SUMMARY, CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS FOR FURTHER STUDY Summary The p u r p o s e o f t h i s s t u d y was t o d e t e r m i n e s t a f f n u r s e s ' p e r c e p t i o n s o f t h e p r o f e s s i o n o f n u r s i n g . S i n c e n u r s i n g i s c u r r e n t l y i n a s t a t e o f t r a n s i t i o n , a t t e m p t i n g t o d e v e l o p i t s p r o f e s s i o n a l i d e n t i t y , i t i s o f i n t e r e s t t o e x a m i n e how n u r s i n g i s p r o c e e d i n g i n i t s p u r s u i t o f r e c o g n i t i o n a s a f u l l y q u a l i f i e d p r o f e s s i o n . The l a c k o f r e s e a r c h i n t h e a r e a was a s t i m u l u s f o r i n v e s t i g a t i o n o f t h e s e c o n c e r n s . The c o n c e p t s o f " p r o f e s s i o n " and " p r o f e s s i o n a l i z a t i o n , " and t h e v a r i a b l e s i d e n t i f i e d i n t h e l i t e r a t u r e a s p o s s i b l y i n f l u e n c i n g n u r s e s ' p e r c e p t i o n s o f t h e p r o f e s s i o n , a g e , e d u c a t i o n , number o f y e a r s w o r k e d s i n c e g r a d u a t i o n , l e n g t h o f t i m e i n p r e s e n t e m p l o y m e n t , and a g e n c y o f employment were u s e d t o f o r m t h e b a s i s f o r t h i s s t u d y . The s t u d y was a d e s c r i p t i v e s u r v e y o f t h e p e r c e p t i o n s o f t h e p r o f e s s i o n o f n u r s i n g h e l d by s t a f f n u r s e s i n B r i t i s h C o l u m b i a . A random s a m p l e o f 600 s t a f f n u r s e s who had p r a c t i c e d f u l l - t i m e a s g e n e r a l d u t y n u r s e s f o r a t l e a s t s i x months i n i n s t i t u t i o n s a n y w h e r e i n B r i t i s h C o l u m b i a were i n c l u d e d i n t h e s t u d y . The n u r s e s were s e n t e x p l a n a t o r y l e t t e r s a n d a d d r e s s e d , s t a m p e d e n v e l o p e s , a co d e d V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e , and a b a c k g r o u n d i n f o r m a t i o n q u e s t i o n n a i r e . The 600 s e t s o f q u e s t i o n n a i r e s w e re s e n t o u t f r o m t h e R.N.A.B.C. i n e a r l y J a n u a r y , 1985. A f t e r a s e c o n d m a i l i n g a t o t a l o f 336 ( 5 6 % ) were r e t u r n e d . Some q u e s t i o n n a i r e s were r e t u r n e d u n a n s w e r e d . O t h e r s w e r e p a r t i a l l y c o m p l e t e d and were o m i t t e d f r o m a n a l y s i s . T h u s , o f t h e t o t a l 600 s e t s o f q u e s t i o n n a i r e s m a i l e d o u t , 262 ( 4 4 . 6 % ) w ere p o t e n t i a l l y u s e f u l . The s a m p l e c o n s i s t e d o f s t a f f n u r s e s who r a n g e d i n age f r o m 21 t o 64 y e a r s , t h e m a j o r i t y ( 8 1 . 3 % ) o f whom h e l d a d i p l o m a i n n u r s i n g , and had w o r k e d a n y w h e r e f r o m 0.5 t o 37 y e a r s s i n c e g r a d u a t i o n . The m a j o r i t y o f t h e s a m p l e ( 6 2 . 1 % ) had w o r k e d 3 o r more y e a r s i n t h e i r c u r r e n t j o b s , o f w h i c h 90% were i n a c u t e c a r e h o s p i t a l s . The s a m p l e d e v i a t e d f r o m t h e p o p u l a t i o n s i g n i f i c a n t l y i n a l l a r e a s o f c o m p a r i s o n , e x c e p t f o r t h a t o f a g e . The V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e was u s e d 56 t o m e a sure p e r c e p t i o n s o f t h e p r o f e s s i o n o f n u r s i n g . The q u e s t i o n n a i r e c o n s i s t s o f 25 s t a t e m e n t s t o w h i c h s u b j e c t s r e s p o n d by u s i n g a f i v e p o i n t s c a l e r a n g i n g f r o m s t r o n g l y a g r e e t o s t r o n g l y d i s a g r e e . To i n t e r p r e t t h e s c o r e s , t h e m i d p o i n t o f a minimum, o f -50 and a maximum o f +50 i s 0 and was d e f i n e d as t h e d i v i s i o n b e t w e e n a g r e e m e n t and l a c k o f a g r e e m e n t w i t h V a l i g a ' s d e f i n i t i o n o f t h e p r o f e s s i o n o f n u r s i n g , and +25 (75%) was d e f i n e d as t h e d i v i s i o n b e t w e e n a g r e e m e n t and a v e r y h i g h l e v e l o f a g r e e m e n t w i t h V a l i g a ' s d e f i n i t i o n . The minimum s c o r e on t h e V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e , was 0 and t h e maximum s c o r e o b t a i n e d was 45, w i t h a mean o f 23. These f i n d i n g s i n d i c a t e t h a t a l l o f t h e r e s p o n d e n t s s u p p o r t V a l i g a ' s c o n c e p t i o n o f a p r o f e s s i o n s i n c e a l l r e c e i v e d s c o r e s a t o r ab o v e t h e m i d p o i n t o f 0, and t h a t 94 (35.9%) a g r e e v e r y s t r o n g l y w i t h V a l i g a s i n c e t h e y r e c e i v e d s c o r e s a b o v e 25 (75%). I n d e t e r m i n i n g t h e r e l a t i o n s h i p b e t w e e n t h e s c o r e s o b t a i n e d on t h e V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e and t h e s p e c i f i e d v a r i a b l e s , a v a r i e t y o f s t a t i s t i c a l a n a l y s e s was p e r f o r m e d . A l l r e s u l t s were t e s t e d a t a .05 l e v e l o f s i g n i f i c a n c e . P e a r s o n p r o d u c t - m o m e n t c o r r e l a t i o n s were u t i l i z e d t o e x a m i n e t h e r e l a t i o n s h i p s b e t w e e n t h e 57 s c o r e s and age and s c o r e s and number o f y e a r s w o r k e d s i n c e g r a d u a t i o n . B o t h r e l a t i o n s were f o u n d t o be i n v e r s e , b u t n e i t h e r was s t a t i s t i c a l l y s i g n i f i c a n t . A n a l y s i s o f v a r i a n c e was u s e d t o e x a m i n e t h e r e l a t i o n s h i p s b e t w e e n s c o r e s and e d u c a t i o n and s c o r e s and l e n g t h o f t i m e i n p r e s e n t e m p l o y m e n t . No s t a t i s t i c a l l y s i g n i f i c a n t r e l a t i o n s h i p was f o u n d i n e i t h e r c a s e . B e c a u s e t h e l a r g e m a j o r i t y o f r e s p o n d e n t s ( 9 0 % ) were e m p l o y e d i n a c u t e c a r e h o s p i t a l s no a n a l y s i s o f t h e r e l a t i o n s h i p o f a g e n c y o f employment and s c o r e s was u n d e r t a k e n . C o n c l u s i o n s The f o l l o w i n g a r e c o n c l u s i o n s t o be drawn f r o m t h e f i n d i n g s o f t h e s t u d y : 1. The c o m p a r i s o n o f t h e b a c k g r o u n d i n f o r m a t i o n o f t h e s a m p l e t o t h e g e n e r a l p o p u l a t i o n o f s t a f f n u r s e s i n B r i t i s h C o l u m b i a i n d i c a t e d t h a t t h e s a m p l e was s i g n i f i c a n t l y d i f f e r e n t f r o m t h e p o p u l a t i o n i n a l l a r e a s o f c o m p a r i s o n e x c e p t f o r a g e , so t h e f i n d i n g s c a n n o t be g e n e r a l i z e d t o t h e p o p u l a t i o n . 2. A l l o f t h e r e s p o n d e n t s s c o r e d a t o r a b o v e t h e m i d p o i n t o f s c o r e s r a n g i n g f r o m -50 t o +50, i n d i c a t i n g a h i g h l e v e l o f a g r e e m e n t w i t h V a l i g a ' s c o n c e p t i o n o f t h e p r o f e s s i o n o f n u r s i n g . The s i m i l a r s c o r e s may be due t o t h e f a c t t h a t t h e g r o u p i s g e n e r a l l y v e r y s i m i l a r i n t h e i r e d u c a t i o n a l b a c k g r o u n d , a s w e l l a s t h e i r p l a c e o f e m p l o y m e n t , s i n c e t h e m a j o r i t y o f r e s p o n d e n t s i n d i c a t e d t h a t t h e i r h i g h e s t l e v e l o f n u r s i n g e d u c a t i o n was a d i p l o m a , and 90% were e m p l o y e d i n a c u t e c a r e h o s p i t a l s . 3. A l t h o u g h none o f t h e v a r i a b l e s s t u d i e d was s i g n i f i c a n t l y r e l a t e d t o t h e s c o r e s o b t a i n e d on t h e V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e , i t c a n n o t be c o n c l u d e d t h a t t h e y may n o t have an e f f e c t on how n u r s e s p e r c e i v e t h e p r o f e s s i o n o f n u r s i n g . I m p l i c a t i o n s W h i l e t h e f o c u s o f t h i s s t u d y was on s t a f f n u r s e s w o r k i n g i n i n s t i t u t i o n s , t h e f i n d i n g s h a v e 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 o r s a s w e l l . T h ese i n c l u d e : 1. A l t h o u g h n o t s i g n i f i c a n t , t h e i n v e r s e r e l a t i o n s h i p b e t w e e n t h e number o f y e a r s w o r k e d s i n c e g r a d u a t i o n and t h e s c o r e s o b t a i n e d on t h e V i e w s A b o u t 59 N u r s i n g Q u e s t i o n n a i r e , as w e l l as age i n r e l a t i o n s h i p t o t h e s c o r e s , s h o u l d a l e r t e d u c a t o r s i n u n i v e r s i t i e s t h a t when n u r s e s who h a v e g r a d u a t e d some y e a r s ago r e t u r n t o s c h o o l t o f u r t h e r t h e i r e d u c a t i o n , t h e y may r e q u i r e a d i f f e r e n t a p p r o a c h and p e r h a p s more t i m e t h a n more r e c e n t l y e d u c a t e d n u r s e s i n a d o p t i n g t h e p r o f e s s i o n a l v a l u e s t a u g h t i n a b a c c a l a u r e a t e p r o g r a m . A d m i n i s t r a t o r s i n p r a c t i c e s e t t i n g s s h o u l d a l s o k e e p t h i s i n m i n d when t h e y ask n u r s e s t o be more a u t o n o m o u s , i n d e p e n d e n t and r e s p o n s i b l e i n p r o v i d i n g n u r s i n g c a r e . 2. The d a t a p r e s e n t e d i n d i c a t e t h a t a l l o f t h e s t a f f n u r s e s i n t h e s a m p l e h a v e p r o f e s s i o n a l p e r c e p t i o n s c o n g r u e n t w i t h t h o s e h e l d by V a l i g a . W hether t h e s e p e r c e p t i o n s were d e v e l o p e d i n t h e e d u c a t i o n a l s e t t i n g o r i n t h e work e n v i r o n m e n t i s unknown. N u r s i n g e d u c a t o r s m u s t , h o w e v e r , c o n t i n u e t o h e l p s t u d e n t s d e v e l o p a t t i t u d e s t h a t a r e c o n s i s t e n t w i t h t h e c h a r a c t e r i s t i c s o f a p r o f e s s i o n , w h i l e t h o s e i n p r a c t i c e s e t t i n g s must p r o v i d e work e n v i r o n m e n t s t h a t f o s t e r t h e d e v e l o p m e n t o f t h e s e a t t i t u d e s , i f t h e s e p o s i t i v e a t t i t u d e s a r e t o c o n t i n u e o v e r t i m e . 3. The r e s u l t s o f t h e s t u d y r e f l e c t t h e v i e w s o f t h e p r o f e s s i o n a l s t a t u s o f n u r s i n g h e l d by a s a m p l e o f s t a f f n u r s e s i n B r i t i s h C o l u m b i a . S i n c e t h e s t u d y c o n c e r n e d i s s u e s s i m i l a r t o t h o s e d e a l t w i t h i n t h e p r o f e s s i o n a l Code o f E t h i c s , t h e r e s u l t s o f t h e s t u d y may p r o v i d e t h e p r o f e s s i o n a l a s s o c i a t i o n w i t h d i r e c t i o n f o r p r o m o t i n g w i d e s p r e a d a d o p t i o n and use o f t h e Code by p r o f e s s i o n a l n u r s e s . R e c o m m e n d a t i o n s F o r F u r t h e r S t u d y The f i n d i n g s o f t h i s s t u d y and t h e i n t e r p r e t a t i o n o f t h e d a t a a r e a l l s o u r c e s o f s t i m u l a t i o n f o r f u t u r e r e s e a r c h a b o u t p e r c e p t i o n s o f t h e p r o f e s s i o n o f n u r s i n g . The r e c o m m e n d a t i o n s i n c l u d e 1. A l o n g i t u d i n a l s t u d y b e g i n n i n g w h i l e n u r s e s a r e s t i l l i n t h e e d u c a t i o n a l s e t t i n g a n d c o n t i n u i n g o v e r t i m e and i n t o t h e p r a c t i c e s e t t i n g . T h i s t y p e o f s t u d y s h o u l d y i e l d v a l u a b l e i n f o r m a t i o n a b o u t t h e p e r c e p t i o n s a b o u t t h e p r o f e s s i o n d e v e l o p e d i n s c h o o l , and i f , i n f a c t , t h e y r e m a i n t h e same o r ch a n g e o v e r t i m e . 2. A s t u d y c o m p a r i n g s t u d e n t s i n d i f f e r e n t t y p e s o f n u r s i n g p r o g r a m s , t o d e t e r m i n e i f , i n f a c t , t h e p a r t i c u l a r t y p e o f e d u c a t i o n makes a d i f f e r e n c e i n t h e p e r c e p t i o n s s t u d e n t s have o f t h e p r o f e s s i o n . 61 3. A s t u d y c o m p a r i n g s t a f f n u r s e s i n d i f f e r e n t i n s t i t u t i o n s t o p r o v i d e i n f o r m a t i o n a b o u t t h e i n f l u e n c e o f t h e e n v i r o n m e n t on v i e w s o f n u r s i n g . 4 . F u r t h e r d e v e l o p m e n t o f t h e V i e w s A b o u t N u r s i n g Q u e s t i o n n a i r e , u t i l i z i n g a s i m p l e , r e l i a b l e m ethod and s t a n d a r d f o r s c o r i n g and i n t e r p r e t i n g r e s u l t s . 62 REFERENCES B r o w n , J u l i a , S w i f t , Y v o n n e , & Oberman, Mary. ( 1 9 7 4 ) . B a c c a l a u r e a t e s t u d e n t s ' images o f n u r s i n g : A r e p l i c a t i o n N u r s i n g R e s e a r c h , 2 3 ( 1 ) , 53-59. Conway, Mary E. ( 1 9 8 3 ) . P r e s c r i p t i o n f o r p r o f e s s i o n a l i z a t i o n . I n Norma L. C h a s k a ( E d . ) , The n u r s i n g p r o f e s s i o n : A t i m e t o s p e a k . ( p p . 2 9 - 3 7 ) . T o r o n t o : M c G r a w - H i l l Book Company. C o r w i n , R.G., & T a v e s , M a r v i n J . ( 1 9 6 2 ) . Some c o n c o m i t a n t s o f b u r e a u c r a t i c a n d p r o f e s s i o n a l c o n c e p t i o n o f t h e n u r s e r o l e . N u r s i n g R e s e a r c h , 1 1 ( 4 ) , 223-227. C u n n i n g h a m , C a r o l y n A. ( 1 9 8 0 ) . P r o f e s s i o n a l n u r s i n g p r a c t i c e i n t h e h o s p i t a l s e t t i n g . S u p e r v i s o r N u r s e , 1 1 ( 8 ) , 26-34. D a v i s , F r e d , & O l e s e n , V i r g i n i a L. ( 1 9 6 4 ) . B a c c a l a u r e a t e s t u d e n t s ' i m a g e s o f n u r s i n g . N u r s i n g R e s e a r c h , ] _ 3 ( 1 ) , 8-15. G r e e n w o o d , E r n e s t . ( 1 9 5 7 ) . A t t r i b u t e s o f a p r o f e s s i o n . S o c i a l Work, _ 2 ( 3 ) , 4 5 - 5 5 . G r e i n e r , P h i l i p A. ( 1 9 8 1 ) . What has become o f t h e t r a d i t i o n a l n u r s e ? N u r s i n g O u t l o o k , 2 9 ( 2 ) , 7 2 0 - 7 2 1 . Hughes, E v e r e t t C. ( 1 9 6 0 ) . The p r o f e s s i o n i n s o c i e t y . C a n a d i a n j o u r n a l o f E c o n o m i c s and P o l i t i c a l S c i e n c e , X X V I ( l ) , 5 4 - 6 1 . J o h n s o n , T e r e n c e . ( 1 9 7 2 ) . P r o f e s s i o n s and p o w e r . L o n d o n : The M a c M i l l a n P r e s s L t d . K e r g i n , D.J. ( 1 9 6 8 ) . An e x p l o r a t o r y s t u d y o f t h e p r o f e s s i o n a l i z a t i o n o f r e g i s t e r e d n u r s e s i n O n t a r i o and t h e i m p l i c a t i o n s f o r t h e s u p p o r t o f c h a n g e i n b a s i c n u r s i n g e d u c a t i o n a l p r o g r a m s . U n p u b l i s h e d d o c t o r a l d i s s e r t a t i o n , The U n i v e r s i t y o f M i c h i g a n , Ann A r b o r . K r a m e r , M a r l e n e . ( 1 9 7 4 ) . R e a l i t y S h o c k : Why n u r s e s l e a v e n u r s i n g . S a i n t L o u i s : The C.V. Mosby Company. K r a m e r , M a r l e n e . ( 1 9 7 0 ) . R o l e c o n c e p t i o n s o f b a c c a l a u r e a t e n u r s e s and s u c c e s s i n h o s p i t a l n u r s i n g . N u r s i n g R e s e a r c h , 1_9(5), 428-439. K r a m e r , M a r l e n e . ( 1 9 6 6 ) . The new g r a d u a t e s p e a k s . A m e r i c a n J o u r n a l o f N u r s i n g , 66_(11), 2 420-2424. K r a m e r , M a r l e n e . ( 1 9 6 9 ) . The new g r a d u a t e s p e a k s - A g a i n . A m e r i c a n J o u r n a l o f N u r s i n g , 6 9 ( 9 ) , 1 9 0 3 - 1 9 0 7 . L e w i s , Roy, & Maude, A n g u s . ( 1 9 5 2 ) . P r o f e s s i o n a l  p e o p l e . L o n d o n : P h o e n i x House L t d . M c C l o s k e y , J o a n n e Comi. (1983). N u r s i n g e d u c a t i o n and j o b e f f e c t i v e n e s s . N u r s i n g R e s e a r c h , 32(1), 53-58. M c G l o t h l i n , W i l l i a m J . (1960). P a t t e r n s o f p r o f e s s i o n a l e d u c a t i o n . New Y o r k : G.P. Putnam's S o n s . M e i s e n h e l d e r , J a n i c e B. (1981). The new g r a d u a t e s o c i a l i z a t i o n . J o u r n a l o f C o n t i n u i n g E d u c a t i o n i n N u r s i n g , _12(3), 16-22. M u f f , J a n e t . (1982). Handmaiden, b a t t l e - a x , w h o r e . I n J a n e t M u f f ( E d . ) , S o c i a l i z a t i o n , s e x i s m , and s t e r e o t y p i n g , ( p p . 113-156). L o n d o n : The C.V. Mosby Company. P o l i t , D e n i s e , & H u n g l e r , B e r n a d e t t e . (1983). N u r s i n g r e s e a r c h : P r i n c i p l e s and methods (2nd e d . ) . T o r o n t o : J . B. L i p p i n c o t t Company. O l e s e n , V i r g i n i a L., & W h i t t a k e r , E l v i W. (1968).The S i l e n t D i a l o g u e . San F r a n c i s c o : J o s s e y - B a s s I n c . , P u b l i s h e r s . Q u i n t , J e a n n e C. (1967). R o l e m o d e l s and t h e p r o f e s s i o n a l n u r s e i d e n t i t y . J o u r n a l o f N u r s i n g E d u c a t i o n , 6_(2) , 11-16. R o t t k a m p , B a r b a r a C. (1980). S u r v e y o f n u r s e a t t i t u d e s t o w a r d p r o f e s s i o n a l n u r s i n g p r a c t i c e . J o u r n a l o f N u r s i n g E d u c a t i o n , 19(5), 32-38. S i m p s o n , I d a H a r p e r . ( 1 9 7 9 ) . From S t u d e n t t o N u r s e . C a m b r i d g e : C a m b r i d g e U n i v e r s i t y P r e s s . S m i t h , H a r v e y L. ( 1 9 5 8 ) . c o n t i n g e n c i e s o f p r o f e s s i o n a l d i f f e r e n t i a t i o n . A m e r i c a n J o u r n a l o f S o c i o l o g y , L X I I ( 4 ) . 410-414. S t a t i s t i c s C a n a d a . ( 1 9 8 3 ) . H e a l t h and manpower s t a t i s t i c s s e c t i o n : H e a l t h d i v i s i o n . S t a t i s t i c s C a n a d a . S t u a r t , G a i l W. ( 1 9 8 1 ) . How p r o f e s s i o n a l i z e d i s n u r s i n g ? i m a g e , X I I I ( l ) , 1 8 - 2 3 . T e t r e a u l t , A l i c e I d a . ( 1 9 7 6 ) . S e l e c t e d f a c t o r s a s s o c i a t e d w i t h p r o f e s s i o n a l a t t i t u d e s o f b a c c a l a u r e a t e n u r s i n g s t u d e n t s . N u r s i n g R e s e a r c h , 25.(1) , 49-53. V a l i g a , T h e r e s a Mary G. ( 1 9 8 2 ) . The c o g n i t i v e d e v e l o p m e n t and p e r c e p t i o n s a b o u t n u r s i n g as a p r o f e s s i o n o f b a c c a l a u r e a t e n u r s i n g s t u d e n t s . U n p u b l i s h e d d o c t o r a l d i s s e r t a t i o n , C o l u m b i a U n i v e r s i t y , New Y o r k . APPENDIXES 67 APPENDIX A V i e w s a b o u t N u r s i n g Q u e s t i o n n a i r e Form B D i r e c t i o n s t o t h e R e s p o n d e n t . T h r o u g h t h e f o l l o w i n g s t a t e m e n t s , I am a t t e m p t i n g t o a s c e r t a i n t h e i d e a s w h i c h y o u c u r r e n t l y h o l d a b o u t n u r s i n g as a p r o f e s s i o n , t h e r o l e o f t h e n u r s e , and t h e r e l a t i o n s h i p o f t h e n u r s e t o t h e c l i e n t / p a t i e n t and t o t h e p h y s i c i a n a nd o t h e r h e a l t h team c o l l e a g u e s . Read e a c h o f t h e s t a t e m e n t s b e l o w c a r e f u l l y . Then, f o r e a c h s t a t e m e n t , p l e a s e i n d i c a t e w h e t h e r y o u S t r o n g l y A g r e e ( S A ) , A g r e e  ( A ) , a r e U n d e c i d e d o r Do Not Know ( U ) , D i s a g r e e ( D ) , o r S t r o n g l y D i s a g r e e (SD) w i t h t h e s t a t e m e n t . C i r c l e t h e one r e s p o n s e t h a t b e s t e x p r e s s e s y o u r o p i n i o n , and p l e a s e be c e r t a i n y o u r r e s p o n s e t o e a c h s t a t e m e n t i s c l e a r l y m a r k e d . T h e r a r e no r i g h t o r w r o n g a n s w e r s , s o p l e a s e r e s p o n d o p e n l y and h o n e s t l y . Thank y o u 1. N u r s e s must be w i l l i n g t o e n t e r w i t h c l i e n t s / p a t i e n t s SA A U D SD t h o s e h e a l t h - r e l a t e d s i t u a t i o n s w h i c h t h e y c a n n o t f a c e a l o n e . 2. N u r s i n g i s c o n c e r n e d w i t h h e l p i n g p e o p l e m a x i m i z e SA A U D SD t h e i r h e a l t h p o t e n t i a l i n t h e i r p a r t i c u l a r l i f e s i t u a t i o n . 3. O v e r t a c t i o n , d i r e c t e d b y l o g i c a l t h o u g h t , t o w a r d SA A U D SD m e e t i n g t h e c l i e n t ' s / p a t i e n t ' s n e e d s f o r h e l p c o n s t i t u t e s t h e p r a c t i c e o f c l i n i c a l n u r s i n g . 68 4. N u r s e s must assume r e s p o n s i b i l i t y f o r SA A U D SD d i a g n o s i n g and t r e a t i n g human r e s p o n s e s t o a c t u a l o r p o t e n t i a l i l l n e s s . 5. The i n d e p e n d e n t f u n c t i o n s o f n u r s e s i n c l u d e s u p e r v i s i n g SA A U D SD t h e c a r e o f c l i e n t s / p a t i e n t s o b s e r v i n g and r e c o r d i n g , s u p e r v i s i n g n o n - p r o f e s s i o n a l p e r s o n n e l , and h e a l t h t e a c h i n g . 6. N u r s i n g must be c o n c e r n e d e q u a l l y w i t h t h e p r e v e n t i o n SA A U D SD o f d i s e a s e and t h e c o n s e r v a t i o n o f h e a l t h . 7. N u r s i n g i s an e x p r e s s i o n o f on e ' s commitment t o o t h e r s . SA A U D SD 8. N u r s e s must be i n v o l v e d a c t i v e l y i n p r o f e s s i o n a l SA A U D SD o r g a n i z a t i o n s . 9. T h e r e i s d e f i n i t e l y a r i g h t and w r ong way t o do t h i n g s SA A U D SD and a p p r o a c h n u r s i n g s i t u a t i o n s . 10. N u r s e s s h o u l d make w r i t t e n o r v e r b a l c o n t a c t s w i t h a l l SA A U D SD a p p r o p r i a t e p e r s o n s t o a s s u r e c o n t i n u i t y o f n u r s i n g c a r e f o r c l i e n t s / p a t i e n t s . 69 1 1 . The u n i q u e n e s s o f n u r s i n g l i e s i n t h e r e a s o n s f o r SA A U D SD what n u r s e s do i n s o c i e t y , r a t h e r t h a n i n t h e s p e c i f i c t a s k s t h e y p e r f o r m . 12. N u r s e s s h o u l d be c o n c e r n e d p r i m a r i l y w i t h g i v i n g SA A U D SD p h y s i c a l c a r e t o t h e c l i e n t s / p a t i e n t s a s d i r e c t e d by t h e p h y s i c i a n . 1 3 . T h e r e s h o u l d be o n l y one n u r s i n g t h e o r y . SA A U D SD 14. E v a l u a t i o n o f t h e work o f t h e i r p e e r s and o t h e r n u r s i n g SA A U D SD p e r s o n n e l s h o u l d be t h e r e s p o n s i b i l i t y o f n u r s e s . 15. N u r s e s must f o l l o w d o c t o r ' s o r d e r s w i t h o u t q u e s t i o n s . SA A U D SD 16. N u r s e s s h o u l d be f r e e t o p r a c t i c e n u r s i n g a s t h e y SA A U D SD d e f i n e i t w i t h i n t h e s c o p e o f p r o f e s s i o n a l autonomy. 17. N u r s e s s h o u l d assume r e s p o n s i b i l i t y f o r t h e SA A U D SD t o t a l n u r s i n g c a r e o f a c a s e l o a d o f c l i e n t s / p a t i e n t s . 18. N u r s e s s h o u l d u p d a t e t h e i r k n o w l e d g e t h r o u g h l i f e l o n g c o n t i n u i n g e d u c a t i o n . SA A U D SD 7 0 19. N u r s e s must c o n t r o l a n d d i r e c t t h e i r own p r a c t i c e SA A U D SD 20. N u r s e s s h o u l d be r e s p o n s i b l e f o r c o n d u c t i n g n u r s i n g c a r e SA A U D SD c o n f e r e n c e s r o u t i n e l y . 2 1 . N u r s e s must be aware t h a t t h e p e o p l e who r e q u i r e t h e i r SA A U D SD a s s i s t a n c e a r e h e l p l e s s and d e p e n d e n t and u s u a l l y need t o be t o l d what t o do. 22. N u r s e s h a v e a r e s p o n s i b i l i t y f o r d i s c u s s i n g t h e p r o p o s e d SA A U D SD m e d i c a l p l a n o f c a r e w i t h t h e p h y s i c i a n so t h a t i t c a n be a d j u s t e d , i f p o s s i b l e , t o be more a c c e p t a b l e t o t h e c l i e n t / p a t i e n t . 23. N u r s e s must assume r e s p o n s i b i l i t y f o r r e v i e w i n g SA A U D SD and e v a l u a t i n g c a r e p r o v i d e d by n u r s i n g p e e r s . 24. N u r s e s must t a k e d e l i b e r a t e a c t i o n t o a t t a i n i n d e p e n d e n c e SA A U D SD i n n u r s i n g s i t a t u i o n s . 25. N u r s e s must n o t h e s i t a t e t o assume t h e r o l e o f l e a d e r o f SA A U D SD t h e h e a l t h c a r e team when t h e c l i e n t ' s / p a t i e n t ' s p r o b l e m s a r e b e s t met by n u r s e s . P e r m i s s i o n g r a n t e d by V a l i g a f o r use o f t h i s q u e s t i o n n a i r e . 71 APPENDIX B B a c k g r o u n d i n f o r m a t i o n The b a c k g r o u n d i n f o r m a t i o n i s r e q u e s t e d f o r s t a t i s t i c a l a n a l y s i s o n l y . P l e a s e c h e c k w h i c h e v e r d e s c r i p t i o n a p p l i e s t o y o u and f i l l i n t h e r e q u e s t e d i n f o r m a t i o n . A. Age ( y e a r s ) B. N u r s i n g E d u c a t i o n P l e a s e c h e c k t h e h i g h e s t l e v e l c o m p l e t e d . 1. D i p l o m a P r o g r a m (a) C o m u n i t y c o l l e g e o r i n s t i t u t e b a s e d p r o g r a m (b) H o s p i t a l b a s e d p r o g r a m 2. P o s t - b a s i c b a c c a l a u r e a t e p r o g r a m 3. G e n e r i c b a c c a l a u r e a t e p r o g r a m 4. M a s t e r ' s p r o g r a m o r h i g h e r 5. O t h e r s (be s p e c i f i c ) C. L e n g t h o f Employment Y e a r s w o r k i n g s i n c e g r a d u a t i o n . ( y e a r s ) D. L e n g t h o f Time a t P r e s e n t Employment 6 months t o 1 y e a r 1 t o 3 y e a r s 3 t o 5 y e a r s more t h a n 5 y e a r s P l a c e o f Employment A c u t e C a r e H o s p i t a l A c t i v a t i o n / R e h a b . H o s p i t a l P s y c h i a t r i c H o s p i t a l L o n g Term C a r e F a c i l i t y P e r s o n a l C a r e I n t e r m e d i a t e C a r e E x t e n d e d C a r e N u r s i n g Home O t h e r ( p l e a s e s p e c i f y ) 73 APPENDIX C E x p l a n a t o r y L e t t e r D e ar C o l l e a g u e : My name i s H e l e n R e d e k o p p . I am a r e g i s t e r e d n u r s e and a g r a d u a t e s t u d e n t a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a S c h o o l o f N u r s i n g . I w o u l d l i k e t o i n v i t e y ou t o p a r t i c i p a t e i n a s t u d y t h a t f o c u s e s on s t a f f n u r s e s ' v i e w s o f t h e p r o f e s s i o n o f n u r s i n g . I t i s a n t i c i p a t e d t h a t t h e f i n d i n g s w i l l be h e l p f u l i n i d e n t i f y i n g s i m i l a r i t i e s and d i f f e r e n c e s i n v i e w s r e l a t e d t o p r o f e s s i o n a l i s s u e s and may s u g g e s t d i r e c t i o n s f o r a c t i o n o r f u r t h e r s t u d y . A p p r o x i m a t e l y 15 m i n u t e s w i l l be r e q u i r e d t o c o m p l e t e t h e q u e s t i o n n a i r e . The c o m p l e t i o n o f t h e q u e s t i o n n a i r e w i l l be t a k e n as y o u r c o n s e n t t o p a r t i c i p a t e i n t h e s t u d y . P a r t i c i p a t i o n i n t h e s t u d y , o r y o u r r e f u s a l , w i l l n o t j e o p a r d i z e y o u i n any way. A l l i n f o r m a t i o n i s c o n f i d e n t i a l and y o u a r e n o t r e q u i r e d t o i d e n t i f y y o u r s e l f i n any way. i f y o u a r e no l o n g e r e m p l o y e d as a f u l l - t i m e s t a f f n u r s e , p l e a s e r e t u r n t h e q u e s t i o n n a i r e i n t h e e n v e l o p e p r o v i d e d . Upon c o m p l e t i o n o f t h e s t u d y , an a b s t r a c t w i l l 74 be a v a i l a b l e f r o m t h e r e s e a r c h e r upon r e q u e s t . Thank y o u f o r y o u r t i m e , H e l e n R e d e k o p p 

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