SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE NURSING STUDENTS
Out of the 165 participants who responded to the study, 86 (52.4%) were female. One hundred and ten (66.7%) were in the age group 20–24 years with a mean age of 25.3 ± 5.5 years (minimum 20, maximum 60). The majority 103 (80.6%) were single and 147 (89.1%) were Christians. Ninety-five participants (57.6%) were from urban areas and their fathers had attained tertiary education (55.2%). Regarding the institution of study, 84 of the students (50.9%) were from Busitema University. Forty-seven participants (28.5%) were in the third year of study. One hundred twenty-four participants (75.2%) joined through the direct entry scheme and had no prior nursing qualifications (75.2%). Furthermore, fifty-six participants (33.9%) obtained financial support to pursue the program through government sponsorship (Table 1).
Table 1
Socio-demographic characteristics of the nursing students
Variable | Frequency (n = 165) | Percentage (%) |
Age 20–24 | 110 | 66.7 |
≥ 25 | 55 | 33.3 |
Gender | | |
Female | 86 | 52.1 |
Male | 79 | 47.9 |
Marital status | | |
Married | 32 | 19.4 |
Single | 133 | 80.6 |
Home area | | |
Rural | 70 | 42.4 |
Urban | 95 | 57.6 |
Religion | | |
Christian | 147 | 89.1 |
Moslem | 18 | 10.9 |
Institution of study | | |
Busitema University | 84 | 50.9 |
Makerere University | 81 | 49.1 |
Year of study | | |
Year 1 | 42 | 25.5 |
Year 2 | 32 | 19.4 |
Year 3 | 47 | 28.5 |
Year 4 | 44 | 26.7 |
Entry scheme into the University | | |
Direct entry scheme | 124 | 75.2 |
Mature entry scheme | 41 | 24.9 |
Prior academic qualification | | |
Diploma | 41 | 24.9 |
None | 124 | 75.2 |
Father's education level | | |
Illiterate | 10 | 6.1 |
Primary | 26 | 15.8 |
Secondary | 38 | 23.0 |
Tertiary | 91 | 55.2 |
Source of funding for the program | | |
Government sponsored | 56 | 33.9 |
Non-Government Organization | 32 | 19.4 |
Parents/ Guardian | 48 | 29.1 |
Self | 29 | 17.6 |
Nursing Students’ Ranking Of The Nursing Profession And Reasons For Enrolment Into The Nursing Program
Seventy-four participants (44.9%) ranked the nursing profession second choice, followed by sixty-seven of them (40.6%) ranking the profession first choice. Additionally, 54 participants (32.8%) enrolled in the nursing program because of their A’ Level performance, 52 (31.5%) due to the desire to help others, 24 (14.5%) were advised by family and friends, 21 (12.7%) because of financial reasons and availability of jobs while the rest (8.5%) joined because of other reasons. Eighty-two participants (49.7%) had a nurse as a relative. Families of 102 participants (61.8%) had a positive reaction to their enrolment into the nursing profession. Seventy-four participants (44.9%) plan for higher education, followed by 21.8% for nursing administration (n = 36), 15.8% for teaching institution (n = 26), while 19 (11.5%) plan to change careers and only 10 (6.1%) plan to join bedside nursing after graduation.
Qualitative Reasons For Choice Of The Nursing Program
Nursing students had numerous reasons for choosing the nursing profession. The reasons were; availability of the course, admission on merit, poor academic performance in high school, parents’ choice, desire to pursue a medical-related course, failure to get admitted for Medicine and Surgery, and low cut-off points for the Nursing course compared to Medicine and Surgery and interest in nursing.
The participants chose nursing because of their interest in the course. They considered nursing as their first choice at the time of completing high school and applied to join the nursing program. These participants had prior experience or information about the nursing program and therefore applied to join a profession about which they knew.
“I had the interest in nursing so I applied for it without applying for other courses and indeed I was taken on merit because. It was my favorite.” (APN2)
Some participants who were aware that they were academically weak also chose nursing. Admission to the nursing course was a privilege for they were not assured of joining a medical-related course at the University. These participants are content with the nursing program irrespective of social pressure and negative comments about the profession because they believe that their ability to pursue the program is a divine intervention, which would not have been possible without God.
“I used to pray to God to give me any medical course be it Medicine, Nursing, Anesthesia, any medical course because I was not very good at school so I knew my weakness. When I joined, many people were telling me to change the course because the course is not good but, I know who I am.” (APN3)
Some participants had mixed reasons for choosing the nursing profession. The reasons were; availability of the course, low cut-off points, academic performance, and desire to pursue a course from a specific institution. Of these reasons, the desire to pursue a course at a specific institution dominated and was the main reason for their motivation to pursue the program. These participants had the desire to study in a particular University irrespective of the program and so applied to only that institution with an idea that it is where they belong.
“I did not decide to do nursing myself; I was given nursing at the University based on my academic performance. Also, since the admission document showing who has received what was showing that I was given nursing, it was the best option at the moment. I got converted and had to pursue it since I wanted a course from Makerere.” (APN9)
“I wanted to deal with human beings but still I only wanted to study at Busitema University, at least that am sure of. Looking at the cut-off points, I knew nursing would be assured so I applied for only nursing at Busitema.” (APN7)
Other participants were straightforward about choosing the nursing profession because it was the last option. These participants considered medicine and surgery as their first choice but since they failed to get the required points, they took up nursing as a last resort to join the medical field. At the time of admission, these participants were not happy about pursuing the nursing program but later accepted and found comfort in the fact that nursing is also a profession in the health sector.
“When I was studying, my interest was to do medicine and surgery but many times things do not turn out the way you expect so since I failed to get admitted for medicine and surgery, I resorted to joining. In a nutshell, nursing was the last resort to entering the medical field.” (APN8)
“At first, I never wanted to do the course; I wanted to find myself working in a hospital but as a doctor and not a nurse. A doctor is a very big title I wanted just that title. I never wanted anyone to call me a nurse because most people undermine nursing and I also had that mentality that nursing is a weak course until I started doing the course.” (APN11)
Attitudes Of Nursing Students Towards The Nursing Profession
The mean attitude score was 129.9 ± 12.3 (minimum 87, maximum 153). One hundred thirty-five students (81.8%) had positive attitudes towards the Nursing profession. Items in “Properties of the Nursing profession” attracted the highest mean score of 61.9(SD 5.9) and items in the General position of the Nursing profession had the lowest mean score of 27.5(SD 2.6) (Table 2).
Table 2
Mean attitude scores of nursing students obtained from the ASNP
ASNP Subscale | Mean | SD | Minimum | Maximum |
Properties of the Nursing profession | 61.9 | 5.9 | 35 | 71 |
Preference for the Nursing profession | 40.4 | 6.5 | 20 | 52 |
The general position of the Nursing profession | 27.5 | 2.6 | 19 | 34 |
The item “I think communication is crucial in nursing” attracted the highest mean score (3.8), while “Nursing cannot afford any mistakes” attracted the lowest mean score (2.0) among properties of the nursing profession.
“I prefer being unemployed rather than practicing nursing” attracted the highest mean score (3.4) while “I would not like my children to become nurses” and “Nursing is not preferred as a profession unless one has no other choices left” attracted the lowest mean (2.8) on preference to the nursing profession.
The item “I think nurses among all health-care personnel communicate the most with patients” attracted the highest mean (3.7) while “Nurses work under very difficult conditions” attracted the lowest mean(1.7) on the general position of the nursing profession.
There was a statistically significant difference between total attitude scores of nursing students according to the year of study (p = 0.009), entry scheme into the University (p = 0.011), and source of funding towards the academic program (p = 0.024) as shown in Table 3.
Table 3: Comparison of total attitude scores with socio-demographic characteristics
Variable | Negative attitude Freq (%) | Positive attitude Freq (%) | P-value |
Age | | | 0.392 |
20–24 | 22 (73.3) | 88 (65.2) | |
≥ 25 | 8 (26.7) | 47 (34.8) | |
Gender | | | 0.509 |
Female | 14 (46.7) | 72 (53.3) | |
Male | 16 (53.3) | 63 (46.7) | |
Marital status | | | 0.051 |
Married | 2 (6.7) | 30 (22.2) | |
Single | 28 (93.3) | 105 (77.8) | |
Home area | | | 0.766 |
Rural | 12 (40.0) | 58 (42.9) | |
Urban | 18 (60.0) | 77 (57.0) | |
Institution of study | | | 0.186 |
Busitema University | 12 (40.0) | 72 (53.3) | |
Makerere University | 18 (60.0) | 63 (46.7) | |
Year of study | | | 0.009 |
Block 1 | 7 (23.3) | 67 (49.6) | |
Block 2 | 23 (76.7) | 68 (50.4) | |
Religion | | | 0.141 |
Christian | 29 (96.7) | 118 (87.4) | |
Moslem | 1 (3.3) | 17 (12.6) | |
Entry scheme | | | 0.011 |
Direct entry scheme | 28 (93.3) | 96 (71.1) | |
Mature entry scheme | 2 (6.7) | 39 (28.9) | |
Father’s education level | | | 0.507 |
Illiterate | 3 (10.0) | 7 (5.2) | |
Primary | 4 (13.3) | 22 (16.3) | |
Secondary | 9 (30.0) | 29 (21.5) | |
Tertiary | 14 (46.7) | 77 (57.0) | |
Source of funding | | | 0.024 |
Government sponsored | 13 (43.3) | 43 (31.9) | |
Non-Government Organization | 3 (10.0) | 29 (21.5) | |
Parents/ Guardian | 13 (43.3) | 35 (25.9) | |
Self | 1 (3.3) | 28 (20.7) | |
Block 1-Year 1 and Year 2 Block 2-Year 3 and Year 4
Relationship between mean attitude scores and socio-demographic characteristics of the nursing students
The results in Table 4 show that being a nursing student in Block 2, funding by a Non-Government Organization, and by oneself were significantly related to positive attitudes towards the nursing profession with crude odds ratios of 0.31(0.12,0.76 CI), 2.92(0.76,11.17 CI), and 8.47(1.05,68.36 CI) respectively.
The adjusted odds ratios for students in Block 2 years of study and students funded by Non-Government Organizations were 0.26(0.09,0.71 CI) and 4.46(1.09,18.19 CI) and were statistically significant at 5%.
Table 4
Relationship between mean attitude scores and socio-demographic characteristics of the nursing students
Variable | Mean score | SD | Crude Odds ratio (95% CI) | Adjusted Odds ratio (95% CI) |
Year of study | | | | P-value | | P-value |
Block 1 | 132.4 | 12.3 | 1 | | 1 | |
Block 2 | 127.9 | 12.0 | 0.31(0.12 ,0.76) | 0.011 | 0.26(.094,0 .71) | 0.008 |
Source of funding for the program | | | | | | |
Government sponsored | 129.1 | 13.5 | 1 | | 1 | |
Non-Government Organization | 131.8 | 10.9 | 2.92(0.76,11.17) | 0.117 | 4.46(1.09,18.19) | 0.037 |
Parents/Guardian | 127.2 | 12.7 | 0.81(0.33,1.98) | 0.650 | 1.45(0.54,3.92) | |
Self | 133.8 | 9.7 | 8.47(1.05,68.36) | 0.045 | 4.28(0.38,48.25) | |
Block 1-Year 1 and Year 2 Block 2-Year 3 and Year 4
Perceptions Of Nursing Students About The Nursing Profession
Perceptions of the participants about the nursing profession were based on their personal experiences, experiences of colleagues, and observation of how nurses are treated at work.
Two positive perceptions were identified about the nursing profession, nursing is a good and enjoyable course and nursing provides an opportunity to interact more with patients. The majority of the participants appreciated nursing as a good course and the perceptions were expressed as themes discussed below;
Nursing is a good and enjoyable course
Overall, the respondents perceived nursing as a good and enjoyable course, which imparts knowledge needed to care for patients and manage illnesses. Nursing is a good profession because it provides an avenue to serve and care for patients. The participants were content with pursuing the course and had a passion to practice nursing.
“It has been my favorite, am proud of it and want to explore more about how lives are saved, and how to care for the sick. To me it is good because we are working to take care of the patient, irrespective of the course one is doing, we are all geared towards a common goal.”(APN2)
“I have learned many things; I now know what I am capable of doing as a nurse. As long as you know what to do and are competent, you will always get something to do and even if you do not get something to do, it does not mean you just go back home and sit, no, that makes no sense because we have a lot of information to give.” (APN6)
Nursing provides an opportunity to interact more with patients
Nursing as a profession facilitates interaction with patients. Nurses are often the first caregivers to patients and spend more time, talking to the patients and providing all the necessary care to them. Nursing is a close relationship between a nurse and a patient aimed at protecting, promoting, and restoring the well-being of patients.
“You are going to be with the patient right from the time they are brought in up to the time they are discharged when they have improved. So you are in charge of the patient’s life, by the patient’s side, everything depends on you. When they are not able to do something, you help them achieve it or do it for them.” (APN7)
“I did not join because I wanted nursing but as time went on, I started liking the profession, even the patients at the moment because there is direct interaction with the patients. We are always with the patients.”(APN5)
Whereas some of the participants had positive perceptions about the nursing profession, a greater number had negative perceptions. Eight negative themes were identified as discussed below;
The image of the nursing profession
The participants expressed that the nursing profession creates a good public image because of the care nurses offer and the quality time nurses spend with the patients.
“You are near patients, caring for them. It gives you a good public image.” (APN4)
The participants also perceived nursing as a profession that is not popular among the public. According to the participants, the public knows little about the graduate nurses and this has discouraged them from joining the profession. The nursing profession is more vibrant at the certificate and diploma level of qualification and this has created so many questions for the participants about why they chose to pursue a Bachelor’s degree instead of starting at the Certificate or Diploma level.
“People are not sensitized enough about this profession, when you say you’re a nurse at Bachelor’s level, someone wonders what you do, the difference between you and a doctor. People are discouraged from joining the profession. With time students will even stop enrolling into the profession because of fear of what they are going to go through.”(APN10)
“Nursing is not so much recognized, I think because of the way it was initially done; people know it as something that stops at lower levels.”(APN7)
Nursing students had a very poor image of the nursing profession. The profession was described as one that lacks creativity, leans more on history, is not well streamlined, and ignores other key aspects of the profession focusing only on clinical work. The participants saw no specific role they play as a profession in practice and do not advance with a career in nursing because they were afraid to progress and yet remain nothing.
“There is a problem with the people in nursing; lack of creativity and leaning more on history. We keep on looking at people with ancient ideas shaped by a history of the profession and yet they decide what we have to practice so we are always rotating around the same axis. There are things, which should change such as the way senior nurses expect to be treated. ” (APN9)
“It is really hard because most of us wonder, what we are going to do and that is why when you ask the students one on one, they will tell you how they feel when they end up doing the same thing that everyone else is doing, you will see that we don’t see a future in it.”(APN6)
The participants narrated that the various stakeholders marginalize the nursing profession. Nurses are minimized; they are not accorded the respect they deserve despite being the backbone of the healthcare system. According to the participants, the responsible authorities do not handle the issues raised by nurses with urgency.
“It is very unfortunate that people do not appreciate or recognize you. You will bear witness to how the nursing profession is marginalized by respective authorities. This is expected because this seems to be a female-dominated profession and anything that is comprised of women, people tend to underlook it, and people do not look at it as something urgent.” (APN6)
Nursing is a hectic profession
Nursing was described as a very hectic profession where nurses are always attached to patients spending a lot of time with patients and lacking time for themselves and their families. The participants expressed that nurses work for so many hours, doing a lot of work and they were afraid to join the profession.
“Bedside nursing is one of the most hectic activities that a nurse has to undergo because it is a close relationship between you and the patient and you always need to do the needful. This ranges from turning the patient, wound dressing. You always have to be on standby.”(APN2)
“We want to have better standards of living and if we do bedside nursing then we should value our time. If you spend 18 out of 24 hours on the wards, when will you have time for your family and do other personal businesses?”(APN10)
Nursing is a traumatizing profession
The nursing profession was labeled as one that exposes nurses to vast challenges ranging from threats to personal safety to physical and psychological torture. Bedside nurses are more vulnerable to torture and so are the nursing students who are often psychologically tortured by students pursuing other courses and experiences of seeing people die.
“We always look up to clinical work which has exposed us to vast challenges. People tell you they were slapped or disrespected at the clinic. If someone wants to venture into a field they can find comfort. We are being traumatized so being tortured over and over, and in most challenging situations, a nurse is the first to fall so, people see it as a profession of cowards.” (APN9)
“ Of course, the worst thing is losing patients because of some reasons, maybe when you were able to do something but for some reasons you can’t do it because somebody else has to do it, sometimes we are not able to do something about it because of resource constraints.” (APN6)
“Nursing students, if you’re not strong you may even leave the profession. There is a feeling of a minority like when a person tells you, “Oh you are doing nursing, sorry for you” so it creates an inferiority complex, someone feels down that they will not succeed in this world.” (APN4)
Nursing training provides skills and confidence to practice but nurses are not allowed to practice what they are taught at school.
The nursing profession was displayed to have restrictions about what a nurse can and cannot do, although nursing students are equipped with information, skills, and confidence to practice during the training. Additionally, most nurses upon qualification choose to work in the clinical setting and neglect the other fields of nursing such as research and leadership in nursing.
“At the end of it all, what you are taught is not what you are going to practice. It may end in school, you are not going to clerk a patient, you are just going to be looking through the notes a doctor has made.” (APN8)
“This is a vast profession that gives little. It almost gives a third of what its content is, in the context of Bachelor nursing. We have so many roles to play. I used to look at the roles of a nurse and they were vast, but people center more on the clinical work which has more repercussions on them.” (APN9)
There is a bias towards employing lower cadres in nursing compared to the graduate nurses
The ratio of bachelor nurses to lower cadre nurses in practice is low, partly because bachelor nurses are discouraged from practice because of the low pay but most importantly because the employers prefer to recruit and employ nurses with certificate and diploma levels of qualification as opposed to nurses with Bachelor’s degree level of qualification.
“We are training to become Bachelor nurses but we have Certificate nurses and Diploma nurses. Some people say certificate nurses are preferred for employment for example in private hospitals because, for a Bachelor nurse, you will automatically want to earn a lot of money.”(APN3)
“You’re studying but people are telling you, where will you get a job, private sector employs certificate nurses, only the government employs bachelor nurses, who will connect you to get a government job. You need money to get a government job, where will you get the money.” (APN4)
Nursing students and nurses are not valued compared to medical students and doctors
The participants stated that they were minimized by other health professional students, their educators, and senior nurses. The senior nurses tend to respect other health professional students and treasure them while looking down on nursing students and questioning their skills and abilities.
“As a student, am underlooked by physicians on the ward and wherever we are. The medical students look at us like a class lower than them. Even the nurses, our colleagues already in the field consider students of other courses to be more important than us.”(APN5)
“We are not considered as something, we are always minimized, and they feel like we are doing nothing in the medical field. Of recent, I read, when the current interns were striking and one had written something that nurses are useful idiots and I felt bad but had nothing to do.” (APN1)
“People believe Bachelor nurses do not know anything, they are fresh from A’ Level, full of theoretical knowledge but don’t have much hands-on. Sometimes even on the wards, those nurses look at you and say, it’s just the papers but there is nothing much you can do, actually I even know more than you.” (APN8)
Leadership in nursing
The participants described the leadership in nursing as a broken leadership, one that does not fight for the rights and safety of nurses. The nursing leaders as stated, do not mentor the young generation and instead make decisions that lead to the suffering of members of the profession.
“If there is even a chance to fight for their rights, you know every human being must come out to fight for their rights but sometimes they tend to say such statements, ‘For me, I was called to love and serve’ which is okay but if something needs action, you should come and act. ” (APN9)
Poor remuneration of the nurses
Additionally, the participants expressed that the pay nurses receive is too little and not realistic yet their expectation would be, good pay as an incentive to motivate them in doing their work. Nurses are underpaid although they do a lot of work. Nurses work for long hours yet earn less compared to the hectic nature of work they do
“Jobs are there but is the juice worth the squeeze? Is the pay worth the work you are going to do, if someone has seen that going the other side is a better place for me, why settle for less somewhere where you are not even appreciated?”(APN9)
“Many of us after finishing opt for other fields outside nursing just because we know we shall be underpaid yet we have invested a lot to study. Now, we are nursing students but at the end of it all, we are going to join the nurses out there. If those people are crying, do you think we shall yearn to join them and also cry, no.” (APN10)