Investigation of the relationship between working conditions and career barriers of nurses

Abstract

BACKGROUND:

Nurses are the largest part of a country’s healthcare workforce and need to improve themselves professionally and plan careers. If we know the career barriers, it will guide the solution suggestions on this issue.

OBJECTIVE:

To investigate the relationship between working conditions and career barriers experienced by nurses.

METHODS:

This study was conducted using the descriptive type research design involving 379 nurses working in a province of Turkey between May and June 2020. Data were collected using the Sociodemographic Characteristics Form and the Career Barriers in Nursing Scale.

RESULTS:

Of the participants scores, 37.21±12.1 were in the “organizational culture and policies” subscale, 17.46±6.0 in the “personal preferences and perceptions” subscale, 10.97±4.5 in the “negative thoughts about the profession” subscale, 8.37±3.0 in the “stereotypical biases” subscale, and 16.20±5.2 in the “multiple roles” subscale. The average total score of career barriers in nursing was 90.23±27.1.

CONCLUSION:

A significant but weak negative correlation was found between the total average of the Career Barriers in Nursing Scale score and age (r = –0.121; p = 0.019), graduation date (r = –0.025; p = 0.120), and working time (r = –0.019; p = 0.115). No significant correlation was found between working time in the current institution, average working time per week, and total of the Career Barriers in Nursing Scale score.

Keywords

Nursing career hospital health

1 Introduction

An individual’s social background, family relationships, economic status, environment, beliefs and attitudes, expectations, personality, and views about the future of their work are social and psychological factors affecting career choice, which is the first stage of career development [1]. In addition to these factors, changes in the health industry and nursing education affect career choices [2]. The significant gap in the number of nurses in the healthcare industry existing today is expected to increase further by 2024 [3, 4]. This problem can be solved with the employment of new nurses and more effective working conditions. Nurses, the largest part of a country’s healthcare workforce, need to improve themselves professionally and plan careers to positively affect community health [5]. In addition, the expansion of the working areas of nurses and the undergraduate and graduate levels of education contribute to their professionalization [6]. Career development is an independent role of nurses, giving them status, authority, and power [6, 7].

In the literature, individuals face career problems such as double careers, spouses with double careers, glass ceiling syndrome, moonlighting problem, and career plateau [8, 9]. Several circumstances caused by today’s working conditions and changes in the working form and relationships prevent employees, especially female, to achieve their career goals [10]. Nurses, physical reasons such as work stress, burnout, depression resulting from long working hours [11]. and can face several career problems due to numerous environmental and individual reasons, such as gender discrimination, marital status, cultural differences, and working conditions. These problems can change the career planning processes of nurses [12]. Enabling nurses to take more responsibility for their career goals is of critical importance for maintaining the viability of the healthcare system [13]. When the literature is examined, there are limited studies on career barriers in nurses. Thus, this study was conducted to investigate the relationship between working conditions and career barriers experienced by nurses.

2 Methods

2.1 Study population and sampling

The study was conducted using a descriptive and correlational type research design. The study data were collected online using Google Forms from nurses working in two university hospitals, four state hospitals, three private hospitals, and three family health centers/community health centers in the province of Konya, Turkey. The population of the study consisted of 1240 nurses working in the aforementioned institutions and 379 volunteer nurses who agreed to participate in the study.

2.2 Measurements

The sociodemographic characteristics questionnaire consisting of 20 items on sociodemographic characteristics was developed by the authors in accordance with the literature.

The Career Barriers in Nursing Scale, developed by Işci and Aylaz [11] consists of the following five subscales: “organizational culture and policies,” “personal preferences and perceptions,” “multiple roles,” “negative thoughts about the profession,” and “stereotypical biases.” the Career Barriers In Nursing Scale is a 5-point Likert-type scale consisting of 29 items, which are scored by 1 point for “Never prevents,” 2 points for “Does not prevent,” 3 points for “Neutral,” 4 points for “Somewhat prevents,” and 5 points for “Always prevents” responses. The total score of the Career Barriers Nursing Scale ranges from 29 points to 145 points. Higher scores indicate that the career barriers perceived by nurses are high. The Cronbach’s alpha reliability coefficient of the Career Barriers in Nursing Scale was calculated as 0.944 in this study. The Cronbach’s alpha reliability coefficients of the subscales of the Career Barriers in Nursing Scale were 0.925 for the “organizational culture and policies” subscale, 0.814 for the “personal preferences and perceptions” subscale, 0.824 for the “negative thoughts about the profession” subscale, 0.650 for the “stereotypical biases” subscale, and 0.835 for the “multiple roles” subscale.

2.3 Ethical approval

The study was approved by the Non-Pharmaceutical and Medical Device Research Ethics Committee of KTO Karatay University Faculty of Medicine (Date: 22 May 2020; No: 2020/026). The research was conducted in accordance with the Declaration of Helsinki principles.

2.4 Data collection and application of the study

The study was conducted between May and June 2020. Nurses who agreed to participate in the study were asked to fill out the Career Barriers in Nursing Scale and sociodemographic characteristics questionnaire created by the researchers using Google Forms.

2.5 Evaluation of the data

Statistical Package for the Social Sciences (version 20.0; IBM Corp., Armonk, NY, USA) was used to evaluate the data. The number and percentage distributions and mean and standard deviation values were calculated. According to the type of the demographic variable of the participants, the independent samples t-test between the groups, analysis of variance for three or more groups, and Tukey’s test for multiple comparisons were used. P values of < 0.05 were used to denote statistical significance.

3 Results

In this study, which was conducted to determine the career barriers and the factors affecting career barriers of nurses, the sociodemographic variables of the participants and their average scores in the Career Barriers in Nursing Scale were compared. The average scores of the participants in the Career Barriers in Nursing Scale and its subscales were as follows: 37.21±12.1 in the “organizational culture and policies” subscale, 17.46±6.0 in the “personal preferences and perceptions” subscale, 10.97±4.5 in the “negative thoughts about the profession” subscale, 8.37±3.0 in the “stereotypical biases” subscale, and 16.20±5.2 in the “multiple roles” subscale. Furthermore, the average total of the Career Barriers in Nursing Scale score was 90.23±27.1 (Table 1).

Table 1
Average total and subscale scores in the Career Barriers in Nursing Scale (n = 379)

Career Barriers in Nursing Scale and its subscales $\bar{X}$ ±SD Min–max value

Organizational culture and policies 37.21±12.1 11.0±55.0

Personal preferences and perceptions 17.46±6.0 6.0±30.0

Negative thoughts about the profession 10.97±4.5 4.0±20.0

Stereotypical biases 8.37±3.0 3.0±15.0

Multiple roles 16.20±5.2 5.0±25.0

Career Barriers in Nursing total score 90.23±27.1 29.0±144.0

Career Barriers in Nursing Scale and its subscales	$\bar{X}$ ±SD	Min–max value
Organizational culture and policies	37.21±12.1	11.0±55.0
Personal preferences and perceptions	17.46±6.0	6.0±30.0
Negative thoughts about the profession	10.97±4.5	4.0±20.0
Stereotypical biases	8.37±3.0	3.0±15.0
Multiple roles	16.20±5.2	5.0±25.0
Career Barriers in Nursing total score	90.23±27.1	29.0±144.0

The average age of the participants was 31.21±7.28 years. The time after graduation was 10.02±7.51 years, the total working time was 9.40±7.45 years, the working time in the current organization was 8.79±18.77 years, and the average working time per week was 45.76±19.79 hours. Of the participants, 85.8% were female, 57.0% were married, and 50.1% had children. While 61.7% of the participants know career development and career planning, 48.8% had specific career goals or plans for the future. Furthermore, 54.1% of the participants were working in daytime and nighttime (mixed) shifts. Among the participants, 37.2% were working in intensive care units. Most participants (58.8%) were working in a state hospital, had a Bachelor’s degree (60.7%), and were working as a service nurse (72.8%). Finally, 53.32% of the participants stated that they needed training or counseling for career development and planning (Tables 2 3).

Table 2

Comparison of the total score of the Career Barriers in Nursing Scale and subscale scores according to the descriptive characteristics of the participants (n = 379)

Sociodemographic variables	Number (n)	Percentage (%)	Organizational culture and policies	Personal preferences and perceptions	Negative thoughts about the profession	Stereotypical biases	Multiple roles	Career Barriers in Nursing total
			Avg.±SD	Avg.±SD	Avg.±SD	Avg.±SD	Avg.±SD	Avg.±SD
Gender
Female	32	85.8	37.66±11.7	17.60±5.9	11.05±4.5	8.40±3.0	16.37±5.1	91.09±26.3
Male	54	14.2	34.50±14.1	16.64±6.1	10.48±4.7	8.22±3.2	15.20±5.4	85.05±31.3
Test value			T = 1.554	T = 1.085	T = 0.847	T = 0.409	T = 1.531	T = 1.341
p			0.125	0.278	0.397	0.683	0.127	0.185
Marital status
Married	216	57.0	37.64±12.4	17.93±6.1	10.76±4.4	8.44±3.0	16.50±5.1	91.30±27.7
Single	163	43.0	36.63±11.6	16.8±5.7	11.24±4.7	8.28±3.0	15.80±5.2	88.83±26.3
Test value			T = 0.798	T = 1.759	T = –1.013	T = 0.507	T = 1.288	T = 0.877
p			0.426	0.079	0.312	0.613	0.198	0.381
Having children
No	190	50,1	36.63±11,9	16.74±5,9	11.13±4,6	8.30±3,1	15.71±5,1	88.53±26,8
Yes	189	49,9	37.78±12,3	18.18±5,9	10.80±4,5	8.45±2,9	16.68±5,1	91.92±27,3
Test value			T = –0.921	T = –2,353	T = 0.705	T = –0.498	T = –1.820	T = –1.215
p			0.358	0.019	0.481	0.619	0.070	0.225
Career knowledge
Yes	234	61.7	37.13±11.9	16.88±5.7	10.71±4.5	8.11±3.0	15.97±5.2	88.82±26.4
No	145	38.3	37.33±12.4	18.41±6.3	11.37±4.5	8.80±3.0	16.57±5.1	92.51±28.1
Test value			T = –0.151	T = –2.424	T = –1.367	T = –2.152	T = –1.100	T = –1.284
p			0.880	0.016	0.172	0.032	0.272	0.200
Future career
Objectives/Plans
Yes	185	48.8	37.27±11.7	16.99±5.9	11.16±4.7	8.12±3.0	15.87±5.2	89.43±26.5
No	65	17.2	36.55±13.5	17.92±7.0	11.06±4.7	8.09±3.2	15.78±6.2	89.41±31.3
Neutral	129	34.0	37.4±12.01	17.92±5.5	10.65±4.2	8.88±2.9	19.89±4.5	91.79±25.7
Test value			F = 0.122	F = 1.131	F = 0.486	F = 2.687	F = 1.172	F = 0.322
p			0.885	0.324	0.615	0.069	0.182	0.725
Working shift
Daytime	131	34,6	36.94±12.9	18.00 ± 6.2	11.14±4.7	8.52±3.0	16.38±5.4	91.00±29.2
Nighttime	43	11,3	35.25±13.3	15.44 ± 5.7	9.32 ± 4.6	7.51±3.1	14.83±5.7	82.37±29.3
Daytime–nighttime (mixed)	205	54,1	37.79±11.3	17.55±5.8	11.20 ± 4.4	8.46±3.0	16.38±4.8	91.4±25.0
Test value			F = 0.821	F = 3.013	F = 3.168	F = 1.984	F = 1.684	F = 2.055
p			0.441	0.050	0.043	0.139	0.187	0.130
Working unit
Internal service	87	23	34.94±12.8	16.16±6.1	10.67±4.4	7.43 ± 3.1	14.97±5.2	84.19±28.1
Surgical service	37	9.8	36.45±11.4	18.13±5.7	11.54±4.6	8.56±3.3	16.78±4.6	91.48±25.9
Intensive care	141	37.2	38.08±11.2	17.70±5.6	10.75±4.5	8.43±2.8	16.65±4.9	91.63±25.3
Operating room	11	2.9	36.63±12.7	17.27±6.5	11.54±5.3	9.63±2.9	18.09±6.1	93.18±30.6
Emergency service	34	9.0	36.05±13.7	16.55±5.8	10.52±4.0	8.29±2.92	15.38±5.4	86.82±28.0
Other	69	18.2	39.34±12.3	18.76±6.4	11.60±4.9	9.18 ± 3.03	16.63±5.4	95.55±28.4
Test value			F = 1.279	F = 1.780	F = 0.611	F = 3.127	F = 1.844	F = 1.626
p			0.272	0.0116	0.691	0.009	0.103	0.152
Working health care provider
University hospital	83	21.9	36.98±11.5	16.72±5.6	10.15 ± 4.1	7.78 ± 2.8	15.49±5.2	87.14±25.6
State hospital	223	58.8	37.34±12.2	17.49±5.9	11.00±4.5	8.39±3.0	16.54±5.1	90.79±27.2
Private hospital	35	9.2	32.91±12.9	17.08±6.5	10.88±4.7	8.17±3.4	14.54±4.9	83.60 ± 28.4
Family health center/ community health center	28	7.4	39.42±12.3	18.50±6.9	11.92 ± 4.9	9.57 ± 3.1	17.14±6.0	96.57 ± 30.6
Other	10	2.6	44.80±4.1	21.50±4.2	14.70 ± 4.6	10.30±2.4	17.70±3.2	109.00±9.5
Test value			F = 2.352	F = 1.701	F = 2.667	F = 2.947	F = 1.976	F = 2.426
p			0.054	0.149	0.032	0.020	0.098	0.048
Educational status
High school	38	10	32.89±12.4	16.00±6.7	10.47±5.1	8.42±3.4	14.60±4.8	82.39±29.06
Associate degree	38	10	39.76±13.0	16.34±5.6	10.31±4.5	8.65±3.0	15.18±5.6	87.26±27.1
Bachelor’s degree	230	60,7	37.23±12.0	17.81±6.0	11.35±4.5	8.28±3.0	16.48±5.1	91.17±27.3
Master’s degree	73	19,3	39.60±11.3	17.72±5.5	10.36±4.2	8.52±2.9	16.68±5.0	92.90±25.1
Test value			F = 2.594	F = 1.511	F = 1.361	F = 0.235	F = 2.136	F = 1.542
p			0.052	0.211	0.254	0.872	0.095	0.203
Position
Service nurse	276	72.8	37.93±11.5	17.62±5.8	11.09±4.55	8.39±3.0	16.36±5.1	91.41±25.9
Chief nurse	46	12.1	33.39±13.4	16.47±6.4	9.97±4.4	7.80±3.4	14.80±5.0	82.45±29.5
Administrative nurse	14	3.7	39.14±12.0	17.57±6.0	11.35±4.55	9.28±2.9	16.64±5.1	94.00±27.9
Other	43	11.3	36.02±13.7	17.51±6.7	11.09±4.96	8.62±2.9	16.53±5.5	89.79±31.1
Test value			F = 2.117	F = 0.478	F = 0.832	F = 1.051	F = 1.293	F = 1.531
p			0.098	0.698	0.477	0.370	0.277	0.206
Training or consulting
Needs for career
Development and planning
Yes	202	53.3	38.28±11.7	17.59±6.0	10.82±4.6	8.34±3.1	16.56±5.0	91.61±26.94
No	104	27.4	35.74±13.2	17.11±6.4	11.04±4.7	8.16±3.0	15.60±5.5	87.67±29.3
Neutral	73	19.3	36.34±11.3	17.61±5.2	11.26±4.1	8.79±2.85	16.06±4.9	90.08±24.4
Test value			F = 1.742	F = 0.248	F = 0.259	F = 0.949	F = 1.198	F = 0.723
p			0.177	0.780	0.772	0.388	0.303	0.486
Total	379	100

Table 3

Sociodemographic characteristics of the participants

	$\bar{X}$	SD	Min	Max
Age	31.21	7.28	21	58
Graduation period (years)	10.02	7.51	1	40
Working period (years)	9.40	7.45	0	40
Working years in the current institution	8.79	18.77	0	184
Average working	45.76	19.79	4	216

No statistically significant differences in the average total of the Career Barriers in Nursing Scale score and the average of the Career Barriers in Nursing Scale subscale scores were found according to variables, namely, gender, marital status, educational status, working position, and the need for training or counseling for career development and planning (p > 0.05) (Table 2). The average score for the “personal preferences and perceptions” subscale was found to be statistically significant different in terms of having children (p = 0.019). The average score for the “personal preferences and perceptions” subscale of those who have children was higher than that of those without children. In addition, the average scores for the “personal preferences and perceptions” and “stereotypical biases” subscales were statistically significantly different in terms of the level of knowledge regarding career development and planning (p = 0.032). The average score for the “personal preferences and perceptions” subscale of those who lack knowledge about career development and planning was higher than that of those who have knowledge. The average score for the “stereotypical biases” subscale of those who lack knowledge about career development and planning was higher than that of those who have knowledge. The average scores for the “personal preferences and perceptions” (p = 0.050) and “negative thoughts about the profession” (p = 0.043) subscales were statistically significantly different according to the type of work shift. The average score for the “personal preferences and perceptions” subscale of those working at daytime was higher than that of those working at nighttime. The average score for the “negative thoughts about the profession” subscale of those working at daytime/nighttime (mixed) was higher than that of those working at nighttime only (Table 2).

The average score for the “stereotypical biases” subscale significantly differs according to the working unit (p = 0.009). The average score for the “stereotypical bias” subscale of the nurses working in internal services was lower than that of those working in other services. According to the health institution, the average scores for the “negative thoughts about the profession” (p = 0.032) and “stereotypical biases” (p = 0.020) subscales and the total of the Career Barriers in Nursing Scale score (p = 0.048) differ significantly. Those working at other hospitals have a higher score for the “negative thoughts about the profession” subscale than those working at a family health center/community health center and a university hospital. Finally, the average total of the Career Barriers in Nursing Scale score of those working in family health centers/community health centers was higher than that of those working at a private hospital (Table 2).

A significant but weak negative correlation was found between the average total of the Career Barriers in Nursing Scale score and age (r = –0.121; p = 0.019), graduation date (r = –0.025; p = 0.120), and working time (r = –0.019; p = 0.115). No significant correlation was found between working time in the current institution, average working time per week, and total of the Career Barriers in Nursing Scale score (Table 4).

Table 4

The relationship between the Career Barriers in Nursing Scale and sociodemographic characteristics of the participants (n = 379)

		Career Barriers in Nursing Scale
Age	r	–0.121
	p	0.019
Graduation period (years)	r	–0.115
	p	0.025
Working period (years)	r	–0.120
	p	0.019
Working years in the current institution	r	0.082
	p	0.178
Average working time per week	R	0.027
	p	0.600

4 Discussion

This study was conducted to determine the career barriers and factors affecting career barriers of nurses. The average total of the Career Barriers in Nursing Scale score was 90.23±27.1 and the average score for the “personal preferences and perceptions” subscale of those who have children (18.18±5,9) was higher than that of those without children (16.74±5,9). A study on nursing students found that having children is a reason for giving up a professional career after graduation [2]. Having children leads nurses to assume multiple responsibilities, causing them to postpone or cancel career plans. The average score for the “personal preferences and perceptions” subscale of those who lack knowledge of career development and career planning was higher than that of those who have knowledge. Halcomb et al. [14] reported that a lack of clinical skills and knowledge is the main obstacle in choosing a nursing career. Stereotypical thoughts about career development, socioeconomic status, family structure, and working conditions of individuals could affect their career expectations. Studies have reported that nurses have expectations such as “provision of continuous training programs,” “knowledge about career opportunities,” and “orientation and career counseling” [13, 15]. In this study, the average score for the “personal preferences and perceptions” subscale of daytime employees was higher than that of nighttime employees, and the average score for the “negative thoughts about the profession” subscale of daytime–nighttime (mixed) employees was higher than that of nighttime employees. Nurses who work day and night (mixed) shifts cannot devote adequate time to themselves due to the lack of a stable working order, causing the inability to make career plans. In addition, the average score for the “stereotypical bias” subscale of the nurses working in internal services was lower than that of those working in other services. The average total of the Career Barriers in Nursing Scale score of those working in family health centers/community health centers was higher than that of those working at a private hospital. Financial constraints and insufficient resources and labor force in family/community health centers put pressure on nurses while they perform the practices required by the profession [16], which could cause professional burnout and hamper nurses’ career plans.

In this study, the career barriers in nursing increased as age, time from graduation, and working time decreased. In one study, nurses’ belief in the effectiveness of career management increases as their age increases [5]. In the literature, studies have indicated that nurses’ thoughts on career planning and development are not related to age [13, 17]. Those who are new to the nursing profession are more willing to make a career, so they perceive more barriers in this regard.

This study is not without limitations. The results represented only the sample of this study and cannot be generalized.

5 Conclusion and recommendations

Nurses are willing to make career plans and need training in this regard. New and young nurses perceive more career barriers. Accordingly, we recommend the following:

Adding training for career development and planning into the nursing curricula

Providing in-service training related to career planning for working nurses

Organizing certification programs for qualified career planning

Enacting administrative regulations to eliminate institutional barriers that hamper nurses’ careers

Nursing managers should know the career barriers of nurses. It should develop solutions to these barriers. Nursing managers should support nurses’ career planning and provide career development opportunities.

Footnotes

Acknowledgments

The authors are grateful to the editor and anonymous referees for insightful comments that significantly improved the paper. They would like to thank all the nurses for their support to the study. No financial support has been received for this study.

Conflict of interest

None of the authors declare any conflict of interest.

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