| dc.description.abstract | This thesis consists of three papers that aim to increase our knowledge of the determinants of registered nurses’ career choices in the health care sector. In order to deliver services of high quality, health care organizations are dependent on a well-trained workforce of adequate size. The shortage of registered nurses will increase during the next decades, causing growing concern about recruitment and retention. In Norway, there are identified challenges related to management, recruitment, mobilization, retention and competence within health care organizations. Based on practical challenges experienced by health care organizations, this thesis aims to contribute with knowledge on determinants associated with registered nurses’ aspiration to become managers, intention to leave and career choices in-home care services.
Traditionally, the choice of occupation was associated with a linear career path within one organization. Nowadays, careers are increasingly dynamic, and employees are not bound to their initial occupation or organization. Career choices are a recurring issue throughout employees’ careers, and they need to choose what type of organization to work in, type of employment, form of employment and the continuity of employment. Careers have primarily focused on people’s agency and ability to shape their careers, bringing organizations more to the background. Although registered nurses own their careers, careers imply context, and organizations play an important role in employees’ careers through policies and practices.
Managers have an important impact on nurses’ work environment, job satisfaction and careers. Previous studies suggest that registered nurses enter management positions due to feelings of pressure from significant others, and intrinsic factors such as autonomy, new challenges and making a difference. However, there is limited knowledge of registered nurses’ motivation for entering a management position and a call for more studies to expand the knowledge of drivers and barriers in the recruitment and development of nurse managers.
Health care organizations experience a high turnover of registered nurses, which is a risk to patient safety and costly from an economic perspective. The number of nurses who leave their organization or profession concerns health care managers and politicians, as accessible health care of high quality requires a sufficient workforce of registered nurses. Although numerous studies have tried to explain registered nurses’ intention to leave, there are still gaps in the literature and a need for more research.
The demand for registered nurses in health care is highly dependent on the ageing of the population. In the years to come, there is expected to be a significant increase in older people and people receiving nursing care in their homes. In Norway, municipalities are responsible for providing home care services; however, they experience recruitment challenges and need registered nurses with sufficient competence. There are few empirical studies on registered nurses’ career choices in-home care services, and this thesis aim to add to this knowledge.
My overall research aim of this thesis is to contribute with knowledge of determinants associated with registered nurses’ aspiration to become managers, intention to leave and career choices in home care services. The three papers of this thesis address the following research aim: 1) To examine determinants (job demands and job resources) that influence registered nurses’ aspirations to become a manager. 2) To examine the association between supervisor support and ethical dilemmas on registered nurses’ intention to leave, and the mediating role of meaning of work. 3) To explore how contextual and individual factors influence registered nurses career choices in home care services.
The first paper is titled “Making a Career in Hospitals: Determinants of registered nurses’ Aspirations to Become a Manager.” It analyses gender, age, social support of an immediate supervisor, competence development, autonomy, workload, and institutional stress influencing registered nurses’ aspiration to become a manager. Papers 1 and 2 use data from a cross-sectional survey distributed to all employees in one of four regional health authorities in Norway. This paper advances knowledge by showing that the aspiration to take on a managerial role depends on demographic factors and nurses’ experience with work characteristics in their current position.
Paper 2 is titled “The Association of supervisor support and ethical dilemmas on Nurses’ Intention to Leave: the mediating role of the Meaning of Work.” High levels of prosocial motivation often characterize nurses and are considered a reason why they chose the profession. The anticipated increase in demands for nursing care and increased shortage of nurses may cause an increase in nurses’ experience of ethical dilemmas and affect their meaning of work. So far, there is relatively little research conducted on the role of ethical dilemmas and the meaning of work for registered nurses’ intention to leave. As the title indicates, this paper contributes with knowledge on the association of supervisor support and ethical dilemmas on nurses’ intention to leave specialist health care and the mediating role of the meaning of work. The paper contributes to nursing management research by providing knowledge and implications for retaining registered nurses.
Paper 3 is a qualitative study titled “Understanding registered nurses’ career choices: a qualitative study on Nurses’ Career in home care services.” This article explores what influences registered nurses’ career choices in-home care services, such as starting or leaving home care services, changing work hours, taking a specialization, working part-time or full-time, or becoming a resource nurse. The paper uses individual semi-structured interviews with 20 home care nurses from a medium-sized municipality in Norway. Compared to the two first papers, this paper contributes with a more detailed understanding of how individual needs and contextual demands are dynamic and how registered nurses make changes over time to improve person-environment fit.
All three papers emphasize the importance of the social support of an immediate supervisor for the studied career choices. The immediate supervisor is crucial in how workers consider their work environment, as they can control politics, goals, rewards and perceived fairness. Paper 3 shows how line managers can positively and negatively affect nurses’ career choices by being supportive, inspiring, encouraging, or causing frustration and exhaustion. Many nurses enter management positions with little training, and managers in the health care sector generally have a high span of control. The findings suggest that health care organizations should implement practices that support managers, such as mentoring, training and development programs emphasizing supportive leadership. Further, health care organizations should ensure that front-line managers have conditions to exercise supportive leadership.
Further, the findings highlight the importance of the meaning of work, high workload, and ethical dilemmas for nurses’ career choices. Contrary to what we hypothesized, nurses who experienced institutional stress reported an aspiration to become a manager, suggesting that this demand may be a challenging demand. Nurses may proactively want to become managers to change the operation of departments and the hospital’s policies and practices. Job resources and demands seem to act as push or pull factors for nurses’ career choices. Some career transitions are made out of intrinsic motivation towards a new position that provides a better opportunity for satisfying basic psychological needs. Health care organizations should be especially aware of creating a work environment that prevents those career choices that could be an ‘escape’ from work characteristics such as undesirable ethical dilemmas, time pressure, and heavy workload. Considering the anticipated growth in the number of older people and the shortage of nurses, the demands will likely not decrease in the future. Health care organizations should therefore find ways to support nurses in handling high demands at work, such as enabling voice, encouraging staff involvement and training. Further, aligning work with nurses’ interests, values, and strengths can support the meaning of work.
At last, the results illustrate the importance of multiple stakeholders, unexpected events and personal and contextual factors for nurses’ career choices over time. Gender and age relate to career choices, such as the desire to specialize or become a manager. There is a majority of women in the nursing profession, and the results demonstrate how female nurses adjust their work situation to balance family and work, especially in some stages of life. Another important finding is the role of unexpected events caused by factors outside nurses’ control, such as the offer of a job or place of clinical practice. These findings support the view of careers as unpredictable and complex and supporting theories bringing the context and unexpected events back into the study of careers. | en_US |
