School leavers into nursing: a study of high academic achieving school pupils in Scottish schools

ABSTRACT The central objective of the study was to better understand 5th and 6th year school pupils’ perceptions of nursing as a career choice and to obtain current data regarding the recruitment situation pertaining to school leavers pursuing nursing as a career choice. This was achieved by utilising a multi-strategy approach which involved the use of a self-administered questionnaire (n = 1062) and the interviews of 20 paradigmatic cases. The school pupils came from 11 schools, with different socio-demographic profiles, from one educational area in Scotland. The study found that only 8.8% (n = 56) of school pupils who had made a career choice had chosen to pursue nursing as a career, despite the fact that 82.4% of the school pupils in the sample had the necessary academic qualifications to enter the student nurse education programme. Merely 21.2% of all the pupils had actually considered nursing as a career choice. The findings would appear to suggest that those pupils who had chosen to pursue nursing as a career choice are committed to this choice. As 93% of the pupils would still continue to pursue nursing as a career choice even if they obtained better grades in their examinations than they expected. Equally resolute in their choice were the pupils who had chosen not to pursue nursing. Of the school pupils in the sample who had not chosen to pursue nursing as a career choice 88.5% of the school pupils stated that even though they did not get the exam grades that they expected they still would not pursue nursing as a career. What was also significant was that of the school pupils who had not chosen nursing as a career choice 86.9% of the pupils stated that they would not consider nursing as a career option in the future. The gender breakdown of school pupils who had made a career choice showed that 2.5% of male pupils who had made a career choice had chosen to pursue nursing. 14% of female school pupils who had made a career choice had chosen to pursue nursing. Further examination in relation to the gender breakdown of those pupils who had chosen to follow nursing as a career revealed that males only accounted for 12.5% whereas females accounted for 87.5%. This would seem to propose that a gender bias still exists in relation to nursing as a career choice. Nursing was not ranked particularly highly by the pupils as a career choice. Male pupils ranked nursing 13th out of the 14 main career choice categories. While female pupils ranked nursing 8th out of the 14 main career choice categories, this being only slightly better than secretarial/administration. Parents appeared to have a major influence on the pupils’ career choice and there was evidence that parents as well as further significant others were influencing against a career in nursing. Nursing does not seem to be a popular career choice among school pupils. There is strong evidence from the questionnaire data to suggest that there are a number of problem indicators which could propose that recruitment of school pupils into nursing could prove extremely difficult even with the proposed increase in the number of school leavers entering higher education. This could have a serious impact on nursing care delivery within the United Kingdom as the nursing population continues to age. The paradigmatic cases interviewed were 20 high academic achieving school pupils who at one stage in their career choice process had considered nursing as a career choice. Despite considering nursing as a possible career choice none of the 20 pupils went on to pursue nursing as a career. The qualitative interview findings appeared to suggest that nursing was not a credible career choice consideration for high achieving pupils. There was a very strong feeling amongst the pupils that nursing would be a waste of their academic qualifications with a belief that nursing was not a career choice for intelligent pupils with good examination grades. Also that they could help people at a much higher level than nursing by becoming a doctor with a prevailing belief that knowledge and caring are polarised – doctors cure and nurses only care for patients. The status of nursing as a career choice was not high amongst the pupils and this was influenced by the type of person that they had observed who were nurses mostly, in their opinion, women who were weak and had no power within society. Also the perceived nature of the job that nurses do with the prominent belief that what nurses do is principally practical in nature having no intellectual aspects, for example making beds, washing and feeding patients. The influence of significant others, these being specifically parents, guardians, guidance teachers and careers advisors was very apparent in the data in that they had a very negative view regarding nursing as a career choice for high academic achieving school pupils. Participants reported that their parents were actively and vigorously discouraging them away from a career in nursing because of the pupils’ good examination grades and the belief that the pupils could do something better than nursing. Also the participants reported that their guidance teachers and careers advisors were assertively steering them away from nursing as a career choice because of their perception that nursing was a low status career choice requiring little intellectual ability and was on a par with hairdressing, office work and being a secretary. In addition the school pupils stated that guidance teachers and careers advisors were more interested in and attempted to have a greater influence on the career choice of the high academic achieving school pupils opposed to other less academic pupils. Only two of the pupils stated that they believed that their career choice was their own decision. With the majority of school pupils valuing the opinion of their parents regarding career choice and with parents along with associated significant others being a major influence on the school pupils’ career choice and advising against a career in nursing. There was strong evidence from the interview data to suggest that the chances of recruiting high academic achieving school pupils into nursing would appear to be negligible. There was also evidence that the image of nursing as an occupation was an important determining factor in the school pupils’ career choice. The pupils displayed a negative image of nursing and this was influenced by a number of factors. The negative image of nursing depicted in television programmes; the negative image of nursing portrayed by people who are nurses; the sexual stereotype image of female and male nurses; and the image that it is very easy to get into train to be a nurse. What was also concerning was that the pupils had few positive and contemporary images of nursing. Also with regard to the image of nursing the data showed that the pupils considered it important to join a profession. Nursing was deemed not to be a profession and did not merit being a profession because it was believed that the entry to student nurse education programmes is not strictly controlled therefore it is easy to get into nursing. There was a strong consensus among the high achieving school pupils regarding their image of the archetypical school pupil who would select nursing as a career choice – their view was of a predominantly unexceptional individual who was mostly female, no more than average intelligence, kind, caring, good listener, good practically and can follow task orders. This view of the typical school pupil who would enter nursing as a career, that of a person with a low academic achievement record, conflicts with their own personal typology and thus became a further important dissuading factor regarding nursing as a career choice for them. In addition they also witness a certain non academic school pupil type being encouraged towards a career in nursing which again reinforces their image perception that nursing is not a career choice for high academic achieving school pupils. The level of education required to be a nurse was thought, by many high achieving school pupils, not required to be at degree level within a university. This was again based mostly on their perceptions of what nurses’ do. The high academic achieving school pupils were extremely suspicious of nursing as a university programme and doubtful as to the value of a degree in nursing. This again had an adverse effect on their consideration of nursing as a career choice. These doubts and suspicions were manifest in the following main areas – nursing has much lower entry requirements than the entry requirements for other university degree programmes; a degree in nursing does not have the same value as other degrees; nursing is an easy way to get into university – school pupils that universities would never have given admission to in the past are entering nursing degree programmes with much less qualifications than those required to enter any other university degree programme; and nursing should not be a university programme. When the high achieving school pupils were asked to think about how nursing could be made more appealing as a career choice for them four main themes emerged: engagement with nurses also detailed and comprehensive information about nursing as a career; proper nursing work experience; links between schools and schools/departments of nursing within universities; changing/improving/losing the stereotypical image of nursing. Choice of career is one of the major areas of concern for young people nearing the end of their schooling (Alberts et al 2003). In the current discourse on the transition from school to work, career decision making has a pivotal position. With the United Kingdom government’s goal of increasing access to higher education to 50 percent of the 18 – 30 year old population by 2010 (DfES 2003) and the rise in the number of school pupils with good examination results at all grades (SQA 2006; DfES 2007). This will boost the number of school leavers entering higher education and the number of pupils trying to decide on which programme of education to choose (Douglass 2003). Even with this substantial increase in student numbers entering higher education the research data would suggest that the vast majority of these school leavers will not pursue nursing as a career

Reply to: New Meta- and Mega-analyses of Magnetic Resonance Imaging Findings in Schizophrenia: Do They Really Increase Our Knowledge About the Nature of the Disease Process?

This work was supported by National Institute of Biomedical Imaging and Bioengineering Grant No. U54EB020403 (to the ENIGMA consortium)

Mesoscale Eddies Are Oases for Higher Trophic Marine Life

Mesoscale eddies stimulate biological production in the ocean, but knowledge of energy transfers to higher trophic levels within eddies remains fragmented and not quantified. Increasing the knowledge base is constrained by the inability of traditional sampling methods to adequately sample biological processes at the spatio-temporal scales at which they occur

Cortical brain abnormalities in 4474 individuals with schizophrenia and 5098 control subjects via the enhancing neuro Imaging genetics through meta analysis (ENIGMA) Consortium

BACKGROUND: The profile of cortical neuroanatomical abnormalities in schizophrenia is not fully understood, despite hundreds of published structural brain imaging studies. This study presents the first meta-analysis of cortical thickness and surface area abnormalities in schizophrenia conducted by the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) Schizophrenia Working Group. METHODS: The study included data from 4474 individuals with schizophrenia (mean age, 32.3 years; range, 11-78 years; 66% male) and 5098 healthy volunteers (mean age, 32.8 years; range, 10-87 years; 53% male) assessed with standardized methods at 39 centers worldwide. RESULTS: Compared with healthy volunteers, individuals with schizophrenia have widespread thinner cortex (left/right hemisphere: Cohen's d = -0.530/-0.516) and smaller surface area (left/right hemisphere: Cohen's d = -0.251/-0.254), with the largest effect sizes for both in frontal and temporal lobe regions. Regional group differences in cortical thickness remained significant when statistically controlling for global cortical thickness, suggesting regional specificity. In contrast, effects for cortical surface area appear global. Case-control, negative, cortical thickness effect sizes were two to three times larger in individuals receiving antipsychotic medication relative to unmedicated individuals. Negative correlations between age and bilateral temporal pole thickness were stronger in individuals with schizophrenia than in healthy volunteers. Regional cortical thickness showed significant negative correlations with normalized medication dose, symptom severity, and duration of illness and positive correlations with age at onset. CONCLUSIONS: The findings indicate that the ENIGMA meta-analysis approach can achieve robust findings in clinical neuroscience studies; also, medication effects should be taken into account in future genetic association studies of cortical thickness in schizophrenia

Ibrutinib and rituximab versus fludarabine, cyclophosphamide, and rituximab for patients with previously untreated chronic lymphocytic leukaemia (FLAIR): interim analysis of a multicentre, open-label, randomised, phase 3 trial

Background: The approval of Bruton tyrosine kinase (BTK) inhibitors in patients with previously untreated chronic lymphocytic leukaemia (CLL) was based on trials which compared ibrutinib with alkylating agents in patients considered unfit for fludarabine, cyclophosphamide, and rituximab, the most effective chemoimmunotherapy in CLL. We aimed to assess whether ibrutinib and rituximab is superior to fludarabine, cyclophosphamide, and rituximab in terms of progression-free survival. Methods: This study is an interim analysis of FLAIR, which is an open-label, randomised, controlled, phase 3 trial in patients with previously untreated CLL done at 101 UK National Health Service hospitals. Eligible patients were between 18 and 75 years of age with a WHO performance status of 2 or less and disease status requiring treatment according to International Workshop on CLL criteria. Patients with greater than 20% of their CLL cells having the chromosome 17p deletion were excluded. Patients were randomly assigned (1:1) by means of minimisation (Binet stage, age, sex, and centre) with a random element in a web-based system to ibrutinib and rituximab (ibrutinib administered orally at 420 mg/day for up to 6 years; rituximab administered intravenously at 375 mg/m2 on day 1 of cycle 1 and at 500 mg/m2 on day 1 of cycles 2–6 of a 28-day cycle) or fludarabine, cyclophosphamide, and rituximab (fludarabine 24 mg/m2 per day orally on day 1–5, cyclophosphamide 150 mg/m2 per day orally on days 1–5; rituximab as above for up to 6 cycles). The primary endpoint was progression-free survival, analysed by intention to treat. Safety analysis was per protocol. This study is registered with ISRCTN, ISRCTN01844152, and EudraCT, 2013-001944-76, and recruiting is complete. Findings: Between Sept 19, 2014, and July 19, 2018, of 1924 patients assessed for eligibility, 771 were randomly assigned with median age 62 years (IQR 56–67), 565 (73%) were male, 206 (27%) were female and 507 (66%) had a WHO performance status of 0. 385 patients were assigned to fludarabine, cyclophosphamide, and rituximab and 386 patients to ibrutinib and rituximab. After a median follow-up of 53 months (IQR 41–61) and at prespecified interim analysis, median progression-free survival was not reached (NR) with ibrutinib and rituximab and was 67 months (95% CI 63–NR) with fludarabine, cyclophosphamide, and rituximab (hazard ratio 0·44 [95% CI 0·32–0·60]; p<0·0001). The most common grade 3 or 4 adverse event was leukopenia (203 [54%] patients in the fludarabine, cyclophosphamide, and rituximab group and 55 [14%] patients in the ibrutinib and rituximab group. Serious adverse events were reported in 205 (53%) of 384 patients receiving ibrutinib and rituximab compared with 203 (54%) of 378 patients receiving fludarabine, cyclophosphamide, and rituximab. Two deaths in the fludarabine, cyclophosphamide, and rituximab group and three deaths in the ibrutinib and rituximab group were deemed to be probably related to treatment. There were eight sudden unexplained or cardiac deaths in the ibrutinib and rituximab group and two in the fludarabine, cyclophosphamide, and rituximab group. Interpretation: Front line treatment with ibrutinib and rituximab significantly improved progression-free survival compared with fludarabine, cyclophosphamide, and rituximab but did not improve overall survival. A small number of sudden unexplained or cardiac deaths in the ibrutinib and rituximab group were observed largely among patients with existing hypertension or history of cardiac disorder. Funding: Cancer Research UK and Janssen