© Borgis - New Medicine 1/2010, s. 22-24
*Judit Helga Feith1, Péter Balázs2, Erika Garaj1, Ágnes Tóth Kovácsné3, István Vingender1
Plans for working abroad and career preferences among nursing students in Hungary
1Department of Social Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
Head of Department: István Vingender Ph.D.
2Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
Head of Department: Anna Tompa Ph.D.
3Department of Health and Social Care, Széchenyi István University, Győr, Hungary
Head of Department: Sándor Nagy Ph.D.
Summary
Aim. The aim of the present study was to gain an objective evaluation of female nursing students' future work expectations in the context of a national labour market recently integrated with the EU.
Material and method. This study is based on cross-sectional quantitative surveys among female nursing college students in Hungary. There were 267 students invited to participate (41 refused, response rate 84.6%).
Results. Nearly two in ten nursing students (78.3%) taking part in the survey rejected work as a nurse in the future. Those who indicated plans for working abroad (57.0%) were statistically related to several other variables as well. Students were influenced by their pessimistic future expectations, by perceived difficulties in maintaining a present partnership or finding a partner, by opportunities of learning a foreign language in a native environment, and by being a home owner at the time of the survey in Hungary. Future plans that were either extremely career-oriented or extremely child-centred were dismissed by a large percentage of the students.
Conclusion. According to our results the nursing workforce migration will escalate in the future, creating additional disadvantages for the Hungarian health care system.
Introduction
An increasing number of Hungarian physicians, dentists, nurses and other trained health professionals have accepted jobs in more developed European countries following the country's accession to the European Union (EU) on 1 May 2004 (1). Hungary complied with the Bologna Declaration of 19 June 1999 on educational systems and restructured its professional training in health care.
Providing health care with qualified professionals is a worldwide problem. According to the OECD Indicators, the challenge is increasing due to the global workforce migration (2). Nurses are the largest group of health care providers worldwide and are disproportionately women; thus female workforce migration has escalated in recent decades, creating additional disadvantages for women and the health care system (3). The main cause of the lack of professional people is the lack of social appreciation, the possibility of career development and the inappropriate planning of human resources (4).
Studies on the changing nature of women's roles in the family and work have been well documented in the past few decades (5, 6, 7). These studies emerged as a result of a growing number of women in the labour market (8), and because of the rapidly spreading model (9) of the dual wage-earning couple (10). In health care, the majority of studies on these topics have examined the incompatibility of family and work-related roles, specifically the conflicts arising from this incompatibility (11, 12). In Hungary there are many things unchanged in the health care system, including low incomes, inflexible work schedules, changing shifts and night duties, inadequate workplace conditions, lack of proper tools and equipment, and the severe psychological burden placed on employees by the nature of their job (13, 14, 15).
Aim of the study
To our knowledge, there are few studies that have explored the future expectations of students currently studying in health colleges, especially as it relates to their propensity to migrate and their career plans. The aim of the present study was to gain an objective evaluation of female nursing students' future work expectations.
Material and methods
This study is based on cross-sectional quantitative surveys conducted in November 2003 among female nursing college students. Nursing students from all Hungarian higher education institutions were approached in their third or fourth academic year to complete a self-administered questionnaire in a group setting. There were 267 female students who were invited to participate, of whom 41 refused (84.6% response rate, N=226).
Questions included demographic characteristics of the respondents and items related to a chosen profession, career plans, and traditional female roles. The main dependent variables considered in this study were likelihood of working as a nurse and propensity to work abroad after graduation. The questions were selected to take into account the role model and role obligations of the modern woman to compare them with future plans and role assumptions. Cronbach's alpha internal reliability coefficient was applied to scales in the questionnaire. Alpha coefficients ranged between 0.70 and 0.83.
Data from the questionnaires were entered in the SPSS Data Entry. In addition to distribution tests, Pearson's chi-squared test was applied to measure relationships between categorical variables and logistic regression models were applied in order to predict students' future expectations.
Results
The respondents' average age was 23 years. The majority (79.5%) had never been married, 16.5% were living with a partner, 3.6% were married, and one person (0.4%) was divorced. The majority of respondents (78.3%) were planning to enter the nursing profession upon completion of their degree. Students' positive opinion of their college education has a substantial impact on whether they are planning to start working as nurses (p<0.001). Those who clearly rejected entering the nursing profession indicated two main reasons with the same frequency for their decision: first the low level of respect generally shown to this profession (58.1%), and secondly the incompatibility of nursing with family life (58.1%).
More than half (57.0%) of all students surveyed are planning to seek employment abroad. Likewise, 57.4% of those planning to work as a nurse plan to seek work abroad. The motivation most frequently (92.9%) cited was to earn higher wages. This considerable proportion provided strong statistical evidence that a high income and the possibility to move into one's own home (=housing problem) are both strongly motivating. Women are also motivated to work abroad by a desire to learn a foreign language in a native environment (84.3%). A majority (65.4%) of students also believe that working in a foreign country affords the opportunity to gain a higher level of professional knowledge. Geographic location of a college had a clear impact on plans to work abroad, with students in the western regions (near Austria) more likely to report plans to leave Hungary for work than those attending colleges in the east (p<0.001). Students who were not married, who anticipated difficulties in finding a partner, or who were planning on a later date for their first child were more likely to express an interest in working abroad (p=0.014, 0.07, and 0.027, respectively). We have also found statistical evidence (p=0.04) for a relation between having plans for working abroad and a proposed number of children if a student thinks in realistic terms(=proposed number of children).
In the analysis using chi-squared test we have obtained statistical evidence that indicating such plans are influenced by several factors. Since as a rule in the life of a young woman finding a partner, housing problem and proposed number of children are potential and they are related to plans for working abroad, we were interested how the students' formation of plans for working abroad could be influenced by the combination of these variables. To explore their joint effect and to estimate the probability of having plans for working aboard from any values of the predictors we have fitted a binary logistic regression model. In establishing the model the predictive variable proposed number of children was not significant at the 5% level. Omitting this variable from the model did not significantly decrease the value of the log likelihood function (the likelihood ratio test statistic is LR chi2 (4) =7.26, p=0.12), and it led only to insignificant changes in the other predicted parameters. Considering the above we estimated the probability of having plans for working abroad by fitting the model with the predictors " housing problem ” and " finding a partner ”. The value of the likelihood-ratio chi-squared test was LR chi2 (2) =11.66 and p<0.001. The students who are not homeowners are almost three times more likely to plan working abroad. Those who anticipated difficulties in finding a partner are two times more likely to plan working abroad. Among the surveyed students 45 (39.1%) were not only planning to be employed abroad, but had already made some arrangements. In this group 34 persons (37.4%) had decided to enter the nursing profession.
Those who indicated plans for working abroad were statistically related to several other variables as well. Students were influenced by their pessimistic future prospects (p<0.001), by perceived difficulties in maintaining a present partnership or finding a partner (p=0.012), by opportunities of learning a foreign language in a native environment (p<0.001), and by owning a home at the time of the survey (p<0.001).
Most students are planning (52.0%) a professional career, and 87.0% of them wanted to have children (two in a typical situation). According to 62.2% of respondents, childcare was the mother's obligation, but 87.1% clearly rejected the full-time mother and housewife model in the family. One out of three students would remain in their studied profession, qualifying career and motherhood as equally important.
Discussion
It is a worldwide phenomenon that the overwhelming majority of college students and staff members in nursing are women, for women have more positive occupational attitudes than men in this profession and women are more likely than men to accept a lower paying position. However, nearly two in ten nursing students taking part in the survey rejected work as a nurse in the future. This result is alarming for two reasons. First, large amounts of public money are wasted by the state in financing the four-year professional training. Secondly, the permanent shortage of nurses is a long lasting burden in the health service. It should be considered that the shortage of nurses will deteriorate even further, for many students who are now planning to work in health care will after several years leave the service. Being a nurse, they will inevitably meet the real-life problems of their profession (11) (13) (14). The present cross-sectional study will be continued to investigate the real behavioural patterns. It was not a surprise that a relatively large proportion of students are planning to seek employment outside of this country. The strongest motivating factor for working abroad is the considerable wage differences. Having analysed the relevant OECD's statistical reports, it can be concluded that Hungary ranks consistently among the three lowest paid regions for nurses (2). It is a general phenomenon that future expectations of students are idealized and separated from the real situation. Only after graduation are the students confronted with social tensions and stress while seeking a job appropriate for career building. Despite all of these well-known difficulties, the results of the present study indicate that students did not expect any potential future problems arising from conflicts between family and career roles.
Conclusion
1. Our results suggest that students realising such a situation are inclined to look for a solution to their problems outside of the Hungarian health care system.
2. The majority of nursing college students will satisfy at the same time both external requirements and internal expectations that emerge in the family and at the workplace. Most students fail to take into account potential conflicts. Therefore, it must be emphasised that students should be prepared for managing such problems before they enter their chosen profession.
3. New challenges brought about by a globalizing world make it absolutely necessary to continue these investigations in a broader, cross-national context.
Piśmiennictwo
1. Office of Health Authorisation and Administrative Procedures, Hungary. www.eekh.hu 2. OECD Indicators: Health at a Glance. ISBN 92-64-012621 OECD 2005. 3. Kofman E et al.: Gender and International Migration in Europe: Employment, Welfare, and Politics. London, Routledge Press, 2000. 4. Buchan J, Parkin T, Sochalski J: International Nurse Mobility. Trends and Policy Implications. WHO, Geneva, 2003. 5. Nordenmark M: Multiple social roles and well-being. A longitudinal test of the role stress theory and the role expansion theory. Acta Sociologica 2004; 47: 115-126. 6. Greenhaus JH, Collins KM, Shaw JD: The relation between work-family balance and quality of life. Journal of Vocational Behaviour 2003; 63: 510-531. 7. Huang YH et al.: The relationship between work-to-family conflict and family-to-work conflict: a longitudinal study. Journal of Family and Economic Issues 2004; 25: 79-100. 8. Cotter DA, Hermsen JM, Vanneman R: Women's work and working women. The demand for female labour. Gender & Society 2001; 15: 429-452. 9. Byron K: A meta-analytic review of work-family conflict and its antecedents. Journal of Vocational Behaviour 2005; 67: 169-198. 10. Haddock SA et al.: Practices of dual earner couples successfully balancing work and family. Journal of Family and Economic Issues 2006; 27: 207-234. 11. Demir A, Ulusoy M, Ulusoy MF: Investigation of factors influencing burnout levels in the professional and private lives of nurses. International Journal of Nursing Studies 2003; 40: 807-827. 12. Heiligers PJM, Hingstman L: Career preferences and the work-family balance in medicine: gender differences among medical specialists. Social Science & Medicine 2000; 50: 1235-1246. 13. Pikó B: Work-related stress among nurses: challenge for health care institutions. The Journal of the Royal Society of Health 1999; 119: 156-162. 14. Pikó B: Burnout, role conflict, job satisfaction and psychosocial health among Hungarian health care staff. International Journal of Nursing Studies 2006; 43: 311-318. 15. Garaj E, Vingender I: Migráció kezelése a kórházmenedzsmentben (Managing migration in the hospital workforce planning, Hungarian only). Kórház és Orvostechnika 2007; 2: 47-50.
