Choosing the ‘right’ people for nursing: can we recruit to care?

Stereotypical images of nursing and nurses continue to be perpetuated, such as ‘angel of mercy’, ‘a doctor’s handmaiden’ and ‘naughty nurse’ (Salvage, 1982; 1985).

In the UK, in addition to these stereotypes, there is the current media image of nurses as uncaring and lacking in compassion, following the inquiry into poor care highlighted within one English healthcare trust. The findings of the inquiry, chaired by Robert Francis QC, are now referred to as the ‘Francis report’ (Francis, 2013). The image of nurses as ‘uncaring’ could be a result in part of the devolving of the more traditional aspects of nursing to healthcare assistants (HCAs) lacking the knowledge that underpins these duties.In an effort to gain professional recognition, nursing is accused of giving away its fundamental essence of care. Nurses have absorbed some of the technical, diagnostic and treatment aspects of medicine, and have become responsible for administrative and technical aspects of service delivery in preference to their traditional role as main providers of compassionate care. Care for the whole person has become fragmented, leading to questions as to whether care and compassion are still at the heart of contemporary nursing practice.

Pam Smith (2011), in her revisited work on the emotional labour of nursing, questions whether nurses can still care. She suggests that caring has become rhetoric as the philosophy and practice of caring have become separated. Defining a universal image of nursing is problematic, as we all have our own private perception of what being a nurse means to us. Have we all been indoctrinated with a self-sacrificing, Florence Nightingale image of nursing that is now unattainable and misplaced in the modern economy of caring transactions? Media and stereotypical images of nurses add to the misconceptions of what a nursing career in contemporary health care now entails. Francis (2013) argues that student nurses need to be intelligent and caring with an intrinsic desire to help others. They must be motivated to put the welfare of others above their own and be passionate about the values on which nursing is based.

Bournemouth University started a new undergraduate nursing curriculum in September 2013. The curriculum has a humanising ethos underpinning the educational experience

(Hemingway et al, 2012) and is also aligned with  role as main providers of compassionate care. Care for the whole person has become fragmented, leading to questions as to whether care and compassion are still at the heart of contemporary nursing practice.

Pam Smith (2011), in her revisited work on the emotional labour of nursing, questions whether nurses can still care. She suggests that caring has become rhetoric as the philosophy and practice of caring have become separated.

Defining a universal image of nursing is problematic, as we all have our own private perception of what being a nurse means to us. Have we all been indoctrinated with a self-sacrificing, Florence Nightingale image of nursing that is now unattainable and misplaced in the modern economy of caring transactions? Media and stereotypical images of nurses add to the misconceptions of what a nursing career in contemporary health care now entails. Francis (2013) argues that student nurses need to be intelligent and caring with an intrinsic desire to help others. They must be motivated to put the welfare of others above their own and be passionate about the values on which nursing is based.

Bournemouth University started a new undergraduate nursing curriculum in September 2013. The curriculum has a humanising ethos underpinning the educational experience (Hemingway et al, 2012) and is also aligned with

 major issue for renewing the workforce, but also for the financial burdens incurred. High student nurse attrition rates are not a new phenomenon and have been reported for many years (Glossop, 2001; Price, 2002, Dearey et al, 2003). Research cites multiple reasons for the high attrition rates, ranging from family and financial to personal difficulties (White et al, 1999). Wharrad et al (2003) suggest that academic failure was also a reason for students dropping out of undergraduate nursing courses.

However, it is also suggested that there is a discrepancy between what new recruits perceive nursing to be and the reality of the profession. A ‘wrong career choice’ was reported as one of the top five reasons for attrition (White et al, 1999; Glossop, 2002). Pryjmachuk et al (2009) also report on the destructive nature of student attrition on the providers of nurse education. Student nurses who do manage to complete their education often describe experiencing a ‘culture shock’ when they take up their first post, with feelings

of being overwhelmed, under-supported and disillusioned as they undergo the transition from the academic ideal of nursing to the reality of clinical work (Valdez, 2008) and 30–61% of nursing graduates reported that they intended to leave the profession in their first year of employment (Aiken et al, 2001; Boychuk Duchscher and Cowin, 2004). Recruiting candidates with realistic views of the profession could assist with the problems of attrition.

Reflections from some recent interviews that were used to recruit student nurses give some broad insight into the ideals and opinions of people choosing nursing as a career.

Academic and practice personnel work in partnership, undertaking student-nurse interviewing to give a balanced perspective and also to mirror the fact that 50% of the students’ time is spent in clinical practice and the other 50% in undertaking theoretical work. A part of the student-nurse recruitment process entails an interview between the nurse educator and a practice partner (a nurse manager or clinical nurse) with the potential student. A template of questions is used to guide the interviews in order to elicit answers that assist in recruiting potential nurses who have academic abilities and who also display the potential to care.

What follows is an exploration of a number of themes that emerged from the answers that the interviewees gave to these questions The skill of the interviewers is to recruit students who have the potential to care, while also adhering to the academic standards and abilities required of a university degree programme.

When interviewees were asked why they wanted to become a nurse, answers ranged from ‘I have wanted to be a nurse since I was a little girl’ to candidates expressing a desire to do something good with their own lives while feeling that they could make a difference to someone else’s. Interviewees who had cared for a friend or family member said that this had given them the impetus to make health care a career choice. Some described being inspired by nurses whom they had witnessed working and held these images as their role models (Gregg and Magilvy, 2001). The interviewers probed for caring attributes as an adjunct to the ability and desire to understand scientific aspects of patient care. Wanting to ‘care for others’, ‘help people’ and ‘make a difference’ were cited as the main reasons that applicants had been encouraged to make nursing a career choice (Andersson, 1993; Beck, 2000; Mackintosh, 2006).

The interviewees were also asked to explore what it was that they perceived nurses do. These perceptions generally encompassed both technical tasks and the caring aspects of a role.

The impressions of nursing and what nurses do were informed by interviewees’ knowing nurses or experiencing nursing from a health or illness perspective, or through images of nurses represented in the media (Andersson, 1993; Spouse, 2000; Day et al, 2005). Some candidates retained the stereotypical views of nurses and nursing that they had been socialised into holding. Whatever views were articulated, they were positive but generally idealistic. Studies have found that nurses construct an idea of an ‘ideal nurse’ that usually has a focus on caring attributes (Spouse, 2000; Hinds and Harley, 2001).

Interviewees with experience of HCA work were asked to differentiate between this role and the role of a registered nurse. Some found this differentiation hard, while others could see a clear role distinction and could articulate the added accountabilities and regulation that comes with nurse registration. Holland (1999) suggests that student nurses who have worked as HCAs before starting nurse education often have difficulty identifying with their new role.

Brennan and McSherry (2005) also question whether having HCA experience before studying to become a nurse can be a hindrance rather than a benefit to the socialisation process. Some of the candidates were better equipped academically for the demands of study and had experience of independent learning; others were school leavers with minimal self-directed learning skills. Personal wellbeing while learning to be a nurse and a sensible work-life balance were raised as things to consider. Some older interviewees were very motivated to become nurses and were coping with family demands and study while also working in paid employment to achieve the entry criteria to ‘follow their dream’. Younger people who attended for interview were similarly juggling many demands to enable entry to a nursing career. Nursing students are exposed to life and death situations during their time at university.

An exploration of the demands (emotional, physical and academic) of becoming a nurse were raised, as students undertaking courses with a vocational element often lack the freedom of other university students studying more conventional subjects.

Teamwork and communication are highlighted to applicants as essential skills required by nurses, and they were asked to give examples of their experience of both.

Some interviewees were already dealing with complex scenarios in workplaces (health and non–healthcare roles), while others could only draw on minimal experience. Generally, older applicants had more experience, but this was not always the case. Interviewees were also invited to discuss a recent healthcare news story that they had heard about. Most applicants are knowledgeable and have opinions about recent media healthcare stories. The media is often sensationalist when reporting stories that concern nurses. However, interviewees who performed better in other aspects of the interview were able to see the power and detrimental nature of media misrepresentations of nurses. The Francis report was a popular topic of discussion, with the majority of students able to articulate measured views.

There was also a call for good representations of nurses and nursing in the media.

The experiences outlined are of student nurse recruitment and selection processes that meet the NMC (2010) criteria, while also looking for caring attributes. The interviewees recruited undertake the humanised curriculum with caring at its core. The nature/nurture debate surrounding caring is factored into the recruiting and education of nurses, but will this be enough to reduce attrition rates and produce nurses who embody the attributes of the 6Cs?

When nurses qualify and are exposed to challenging work environments, there is a constant need for them to be supported to maintain their caring values. If we can recruit nursing students with the potential and desire to care, we also need to expose them and socialise them to nursing practices that embody and allow for care and compassion. Exposure to a healthcare service that is driven by the economics of the head rather than the passions of the heart may set false expectations from undergraduate nurses studying a humanising curriculum.

Compassionate, empathetic and safe nursing needs to be desired by all, and then nurtured and supported beyond student-nurse recruitment, selection and education. The regulatory bodies, healthcare providers and educators need to work in partnership to provide a unified, humanised approach to patient care that is both realistic and sustainable. Contemporary healthcare needs to decide if it wants to re-embed caring into the heart of nursing practice. Recruiting, selecting and educating nurses are only the start of this process.

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