Scholarship - Career Intention of Baccalaureate Student Nurses: Understanding the Barriers, Enablers, and Predictors Toward Public/Community Health Nursing

This episode of the NLN Nursing EDge Unscripted Scholarship track features guest Angie Docherty. Learn more about her work, Career Intention of Baccalaureate Student Nurses: Understanding the Barriers, Enablers, and Predictors Toward Public/Community Health Nursing.

Docherty, Angie; Franklin, Heather; Voss, Heather; Dieckmann, Nathan. Career Intention of Baccalaureate Student Nurses: Understanding the Barriers, Enablers, and Predictors Toward Public/Community Health Nursing. Nursing Education Perspectives 44(4):p 210-215, 7/8 2023. | DOI: 10.1097/01.NEP.0000000000001108 

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Transcript

0:01

[Music][Music][SP] Welcome to this episode of the NLN podcast Nursing EDge Unscripted Scholarship track. I'm your host  Dr. Steven Palazzo, a member of the editorial board for Nursing Education Perspectives.  Nursing EDge Unscripted and our track entitled Scholarship celebrates the published work of  select nurse educators from the NLN's official journal Nursing Education Perspectives and the  NLN Nursing Edge blog. The conversations embrace the author's unique perspectives on teaching  learning innovations and the implications for nursing program development and enhancement.  In this episode we will discuss the impact of nursing education on career intention related  to public health and community health nursing. We will discuss the author's article, Career Intention  

of Baccalaureate Student Nurses: 1:21

Understanding the Barriers, Enablers, and Predictors Toward Public/  Community Health Nursing. The discussion will focus on the unique findings of the authors who  published this manuscript in the current issue of Nursing Education Perspectives, volume 44 issue 4.  The authors are faculty in the School of Nursing, Oregon Health and Sciences  University in Monmouth, Oregon and today we have Dr. Angie Docherty who is an associate professor,  Heather Franklin is a biostatistician, Heather Voss is an associate professor, and Nathan  Dieckmann is an associate professor. So first please briefly describe the purpose and  methods that you used to conduct your study and what drew you and your group to this question?  [AD] We were particularly drawn to the question by noticing that very few of our graduates go  into the public health arena or even community nursing in general. Most of them choose their  final practicums to be in acute care, critical care, emergency departments, and this is despite  the fact that we spend quite a bit of time in our program and have dedicated courses focusing  on population health and community health. So we wondered what we were doing that was maybe  turning them off public health nursing or what can we do better to turn them on to public Health  nursing. So that was really what we decided would be the kind of main premise of our work.  So what we did was we surveyed all baccalaureate and accelerated baccalaureate  students across the state of Oregon so we did not focus on our RN to BSN as they possibly  were in the workforce already and we really had two aims. We wanted to know when you come  into the nursing program what was your career intention at that time and then  while you've been in the program has that career intention changed in any way? So those were the  two clear aims and we undertook a cross-sectional survey to try and determine those aims and find  out if there was anything, anything at all that was predictive about either their initial influence  or was predictive about whether they changed their intention while they were in the program.  [SP] Well it's a great question. I've always wondered that too. We have quite a few students when they  come into the program already pretty set on what area they want to specialize in and it can become  very difficult to sometimes convince them to look at other specialty areas as a possibility.  We do have some that go, you know, change as they go through the program but you're right  about community and population health. So in your article, can you discuss a little bit more detail  about fixed intention, kind of what you talked about as when they're coming into the program  and how that influenced students intention after graduation? Were you surprised that  nursing curriculum did not have more impact on the students over the their intent? It appears  most of the influence came from outside the nursing program. [AD] That was our main finding and we described that as our freezed fixed intention because largely what we say was that students do come in with a career intention in mind and we saw maybe about a five  percent change in that but certainly they did not come in and we did we did not see any evidence  that as an education program and this is all the schools across Oregon this was not obviously  unique to ours. We did not see any evidence that we as educators or our curriculum we're influencing  career intention in any direction so that was surprising to us and I suppose somewhat depressing  as a public health nurse myself and that we really have certainly in our program worked hard. We've  got a dedicated population health course. I say we spend a lot of time in placements that  are non-traditional, if you like, non-acute based. And what we're seeing was that those who choose to  work in that area already had that destination in mind. [SP] I lived in Washington state for 30 years so  I'm very familiar with Oregon and Oregon's quite a rural state outside the major metropolitan areas.  It does surprise me that more students probably who came from some of those rural  areas too did not have any intent to go back to those rural areas or not in a way that was  population or community focused because it is very community population focused the state kind of  is in that mindset. So what are your thoughts about like a population health internship? So, for example,  the students would go for the whole quarter to three quarters in the year or two semesters in  the year throughout doing their clinical placement there where they're really getting an immersive  type of experience where they're helping actually develop programs within that community partnership  with a population health focus, with the eyes of policy around it, and seeing it towards the end?  Might that grab their attention more or if not what other ideas have you had as as a team to  think about strategies that would get students more interested in community and population health?  [AD] I am intrigued by the public health internship approach. In a way we do something that is similar  to that within the Oregon Health and Science and University curriculum. We have two courses that  follow each other and each of them are 10-week terms one's population health and nursing so  they're out there in population health settings or community settings and then it falls into a  leadership another 0 week course so they really are embedded in population health community health  settings and they work on projects. We don't call it an internship. They're definitely clinical  placements attached to each of the courses, but even with that...so that's 20 weeks essentially  that they're in our program certainly in dedicated placements and that it's still  not moving that needle as we talk about in the paper. And some of them, I mean they're  not all with public health nursing placements and I wonder sometimes if that needs to  be more structured they need to see more of the nursing role in community and population health settings.  We focus a lot on social determinants of health, which is crucial and so our students might be out  in working with homeless organizations, alcohol and tobacco prevention organizations, different agencies that have a focus on social determinants. Some of them are with nurses and  we know there are not enough public health nurses and really well particularly post-Covid.  So we kind of lack that real ability to make sure that all our students are exposed to and  population health nursing or community health nursing roles and I think if  restructured to think about how we really manage that we might be moving in a better direction.  [SP] That's interesting and that's true. It's it's a very difficult  dilemma that's I think faces everyone not just in your state. I mean, I experienced  that here in Florida. I experienced it when I worked in Washington, when I worked in Nevada.  This hesitancy to feel that community population health is going to be the clinical  that's going to help them be successful in the program and I don't know what it is, or you know as  we know nationally the trend is towards moving out of the acute care setting and into the community  setting, the home-based care etc. and there's going to be a need for more nurses  in those areas. What do you think? What do we do? How do we attract more students and really  get them to understand the value of this type of nursing? [AD] Well, that was one of the major   questions that we asked ourselves and why we did this study. One of the findings that we  thought about was if they're coming in with fixed intentions largely then we need  to kind of embed those intentions earlier and we need to be much more intentional about our  outreach work. And we've actually done, you know, there's a follow-up study that we're working on  just now with pre-nursing students where we've really explored the role of nursing from cradle  to grave, focusing very minimally on the acute care but not diminishing that. This particular approach was what can we do to prevent illness and you know really get in there  early and so we work with pre-nursing, but what our next phase will be is that outreach to the  high school, middle school settings because I'm not sure...if you think about where people learn  about nursing you don't see a lot of public health nurses or population health nurses in the media.  Those that wanted to work in population health settings already were aware of that setting and had worked there.  So it tells me that we need to do our education a lot earlier than we're doing about what nursing can be. [SP] Well I  noticed you use social cognitive career theory to guide you as a framework and intention is a big  part of that of course. So as we know intention manifests by many different behavioral cues  and try trying to capture or I guess look at those different parts of the the framework  and what could you make strides and what areas could you look at and I suppose you're going to, are you gonna go forward with some more work in the future with this question? [AD] Yep, as I  said we're doing some work just now and we're looking, I think we're focusing on pre-nurses. We took them through a kind of theatre-style simulation workshop where we really showed them  the role of nurses in non-acute settings including end of life. We kind of looked at different   you know, got some discussion going about that and I think we were successful in opening up their  eyes to while nursing is more than what the acute care setting and hospital-based settings but  I really the goal is to get into high schools and middle schools and start exploring nursing  but from a much more community population and health nursing sort of sense. I think there are  lots of discussions that we can have and really trying reason, excitement, and passion for that  area of nursing. [SP] Well any final words or words of encouragement things that you want to say to the  audience about what the next steps would be if they're having the same dilemma and trying to  to figure out how to do this? [AD] I think the one of the things that came out in our findings  in appearances for a number of years is that students are still being told by the by even by  people working in population health settings that it's a good idea to get a few years of acute care  experience under your belt and I would, I'd really like to send out a message that we stop doing that. [SP] Yes. I agree. [AD] Education programs across the country. We are preparing our students for all settings  in nursing. That's our mandate. That's what we're doing and they need to hear that they  are they are able to work in all settings of nursing from the point of graduation. [SP] I agree.  I tell students all the time when I'm counseling them that if your area of your specialty area is  this, then that's what you go into. You can always go back and do med-surg four or five years from  now if you want. There's going to be a need for med-surg nurses. They will give you a residency  program if you need one. You know, go where your passion is. If it's community health population  health or obstetrics, whatever, don't have to do med-surg for a year or two just  because that's the way it was done 30, 40 years ago, you know. Well I really appreciate your time.  It was a really great conversation and I encourage everyone to take a look at the  

article. It's a really good read: 13:18

Career Intention of Baccalaureate Student Nurses: Understanding  the Barriers, Enablers, and Predictors Toward Public Community Health Nursing. And I want to  thank you so much for joining us today. It's been a real pleasure and again, thank you. [AD] Thank you.[Music]