Adolescents’ perception of career choice of nursing among selected secondary schools in Jos, Nigeria

The main purpose of this study was to examine the adolescents’ perception and choice of nursing as a career in senior secondary schools, and to determine factors that may influence their choice and perception. The study was conducted in four selected schools in Jos metropolis. Each of these schools is unique in features. They include: two government secondary schools (urban and rural) and two private secondary schools (urban and rural). A total of 240 respondents were used for the study. A selfadministered questionnaire was used for data collection. Data collected were analyzed and presented in frequency tables, percentages, bar chart and chi-square. Findings indicate that 7.5% (n=18) of respondents chose nursing as a career, out of which 83.33% (n=15) were females, while 16.67% (n=3) were males. Interestingly, out of 46.25% of total respondents who would consider nursing as a career, 56.76% were females while 43.26% were males. There is no significant relationship between gender in considering nursing as a career choice (X2=3.76, critical value=3.841, df=1, p value=0.05); the ownership type of schools, and consideration of nursing as a career choice shows no significance (t=-2.098, critical value=1.658, df=118, p value=0.05.). There is equally no significant relationship between location (X2=25.5, critical value=3.841, df=1, p value=0.05), and consideration of nursing as a career choice.


INTRODUCTION
Nursing is the largest single health care profession in the health care context (Price et al., 2013). Its central significance anchors on the fact that the care permeates every stratum and segment of any given community. The practitioners' preparations, which are elaborate in nature, places them in a vantage position to render high quality services to the community (IOM, 2009). The sustainability of nursing depends largely on maintaining an equilibrium between those that enter and exit the profession. A multi dimensional perspective about career choice has to be examined in order to situate the choice of nursing as a career among adolescents. Adolescence is a stage imbued with an array of complex physical and socioemotional states. Career choice is one of the critical decisions adolescents (Novakovic and Fouad, 2012) are expected to make as the effective choice will have positive impact on their self-concept development, and fulfillment of one's life purpose. Career choice is greatly influenced by a number of factors. Parental background and communication between parents and children, interests and role models (Sawitiri et al., 2102;Price,2009) (Kanan and Baker, 2006) have shown that there has been some effect of schooling on students' aspirations in terms of quality of school, mainstreaming or tracking, and whether a school is segregated or co-educational. Some individuals see nursing as a calling/vocation; a conviction that drives their interest and passion to pick nursing as a career. Individuals whose career decisions are strongly influenced by religion or spirituality (Hernandez et al., 2011) may refer to their careers as a calling or a vocation. Students (Knight et al., 2011) often begin investigating career choices and discussing their future plans in middle school, and awareness of opportunities should also be a factor when considering a career choice. Individuals have severally attempted to rationalize their choice of nursing. People do give different reasons for choosing nursing as a career. In most cases, altruism and interest have always been the reasons adduced for opting to pick nursing as a career. In a recent study on choice of career in nursing, it was (Jirwe and Rudman, 2012) reported that altruism, and work-related motives have been identified as reasons for becoming a nurse.

Statement of the problem
A myriad of factors modulate the choice of a career by individuals. Choices of careers by individuals are greatly influenced by the individual's perception, expectation, and the necessary environmental support. Nursing, as a career, has been influenced, of recent, by a great deal of correlates, and these vary from one context to another. Contemporary adolescents have a greater access to sophisticated information technology which enables them to have the knowledge of the incidents in other climes than the pre-sophisticated information technology adolescents. Their responsiveness to this thus, sometimes, accounts for changes that hitherto were unexpected. Adolescents' world is characterized by a lot of inconsistencies and contradictions owing to the fact that their decision outcomes are a function of experience, exposure, and reasoning which are not as accurate and developed as that of adults. Studies have shown that the nursing recruits are sourced from all levels of social classes as against the rigid old practice when recruits were mainly drawn from the working class. A couple of developments such as proliferation of university nursing education program, and the enhanced practice have been able to encourage younger ones to develop interest in nursing. However, whether this interest is growing at the same level in every place in Nigeria is another issue on its own.

Research questions
1. What is the perception of nursing among adolescents in senior secondary school? 2. What are the factors that influence their choice of nursing as a career? 3. Does the location of school affect the adolescents' choice of nursing?

Significance of the study
The sustainability of a profession largely depends on maintaining the periodic and consistent inflow of human resources that would keep and maintain the professional expectations and responsibilities of the old members. This new set of recruits would replace those who are exiting the profession thereby maintaining a balance. Failure in this direction would have a direct bearing on the society who is sole beneficiary of the services rendered by members of such profession. The knowledge of patterns of career choice, and factors would help the nurse administrators and policy makers to redirect their efforts toward ensuring sustainable in flow of recruits by adapting the job to gain the career appeal of the younger ones, and making it highly attractive by restructuring the practice, and negotiating the system such that the attendant privileges of a profession would be well pronounced which would serve as a sufficient platform as to attract young individuals.

Literature review
Adolescence (WHO, 2014) is reported to be a period in human growth and development that occurs after childhood and before adulthood, from ages 10 to 19, and represents one of the critical transitions in the life span. There is a report (Gray et al., 2013) that "there are about 1.2 billion adolescents globally, and their development is impacted by poverty, gender inequity, low educational attainment, socio-cultural and regulatory barriers". Adolescents' career choice is one of the most critical decisions they are expected to make as the right choice often leads to self-fulfillment in life. Adolescent girls are more likely (Novakovic and Fouad, 2012) to make career decisions that would be influenced by gender stereotypes and experiences of discrimination in the educational setting. A myriad of early influences (Price et al., 2013), such as gender role orientation, personality, educational experiences and parental and peer interactions impact on occupational choice. Nursing, as a choice of career, they further argue, is likely to be influenced by gender, culture, experiential knowledge, self-concept and altruistic desires to help others. Career choice can be explained using some theoretical assumptions such as Holland's theory of vocational personalities in work environment, social cognitive and self concept theories (Leung, 2008). Holland identified six types of personality in the circular order of realistic, investigative, artistic, social, enterprising and conventional (Tang, 2009). The theory has largely influenced the explanations on how personalities influence career choice in the context of work/job influence career choice in the context of work/job expectations (Tang, 2009). Social cognitive career theory emphasizes the interplay of demographic variables, contextual factors, and life experiences. Self-efficacy, outcome expectations and goals (Lindley et al., 2005) also lead to interest development, career choice, and performance. Self-concept theory assumes that individuals make decisions by comparing their self-images, and that the adequacy of career decisions for individuals is based on the similarity between self-concept, and the career roles that are focused on (Egan et. al., 2006).

Hypotheses
1. There is no statistically significant relationship between location of school and consideration of nursing as career choice.
2. There is no statistically significant relationship between gender and consideration of nursing as a career choice. 3. There is no statistically significant difference in the perception between private and public about nursing in urban area.

RESEARCH DESIGN
This is a cross sectional, descriptive, and non-experimental study aimed at examining the perception and choice of nursing as a career by adolescents in selected secondary schools within Jos metropolis. This is mainly a quantitative study and the intent was to describe the participants' knowledge, perception and the motivations for the choice, and factors influencing their perceptions about nursing as a career choice. Hypotheses generated were tested for relationships among the variables.

Study setting
The study was carried out in Jos, Plateau State. The State is located in the North Central geo-political zone of Nigeria, shares boundaries with Benue, Nassarawa, Kaduna, Taraba and Bauchi States. Jos metropolis is the headquarters of the State with a population of about 900,000s (NPC, 2006). The city is divided into three local government areas: Jos North, Jos East and Jos South Local Government areas. It presents a cosmopolitan outlook as it plays host to indigenes, non-indigenes as well as non-Nigerians. The main city lies between Jos North and Jos South. Jos North is the state capital, forming an agglomeration with the town of Bukuru to constitute the Jos-Bukuru metropolis.

Methods
For this study, a sample of 240 secondary school pupils participated in the study. Four schools, two schools each, public, and privately owned, were purposively chosen from Jos metropolis (an urban setting) and Riyom (a rural setting). Student participants were drawn using systematic sampling procedure with the class registers for senior secondary school classes serving as the sampling frame. The sample had equal gender representations. The instrument used for data collection was a 22-item self-administered questionnaire completed in the classroom. The questionnaire consisted of both closed and open ended questions. The closed ended portion comprised socio-demographic section, and items measuring the perception of nursing (image of nursing), and factors influencing perception of nursing as career choice while the open ended questions were aimed at making some clarifications and explanations on issues bordering on career choice. The questionnaire was pretested using 10 secondary school students from Naraguta Grammar School who were similar in characteristics as the intended study participants. The questionnaire was given to superiors for their meaningful inputs. The questionnaire was found to be valid as it measures the issues it intended to address. The participants' consent was obtained after the permission to carry out the study had been sought from the institution's gatekeepers. They were seated in a convenient hall with some appreciable distance among them to avoid undue influences, and were encouraged to respond to those issues indicated therein honestly. Questionnaire copies were retrieved after completion. The response rate was 100%.

Ethics considerations
Permission to carry out this study was sought from the school gatekeepers, and the students' informed consent was obtained by the researcher. Individuals who expressed their willingness to participate in the study were provided with full explanation of what the study entailed. Participants were given the opportunity to seek clarifications, and ask questions, and that they could at any point withdraw if they so desired without any threat of victimization or harassment. They were assured of their anonymity, and confidentiality of the information volunteered (Table 1)

FINDINGS
The socio demographic data show that 16 to 18 age category constitutes the majority (63.75%) of respondents followed by 13 to 15 age range (26.25%), while 19 to 21 accounts for 10% of the respondents. The data on gender shows a perfect balance (50% each). There is parity in the number of respondents from each of the levels. Preponderance of Christian respondents (91.25%) is found, while Muslims constitute 8.75% of the respondents. The respondent fathers' occupations show that 28.75% are traders/business persons; farmer/ artisans, 21.25%; civil servants, 12.5%; self-employed professionals, 10%, while figures on that of their mothers' show that 32.5% are traders/business persons, farmer/artisans, 25; housewives, 10%; civil servants, 8.75% and others, 1.25%. Table 2 shows that there is a preponderance (57.5%) of the respondents that chose the science stream followed by art (31.25%), and commerce (11.25%). Table  3 shows that majority (88.75%) of respondents did perceive career as a future ambition, while 1.25 and 3.75% of respondents saw career as "what parents want me to be" and" what one does for a living" respectively, and 6.25% of respondents gave zero response (Table 4). Nursing ranks fifth (7.5%) in the career choice preferences with Medicine (31.25%) topping the list while Music/Acting/Journalism/Mass Communication place second (18.75%) Engineering (17.5%) and Law (12.50%) rank third and fourth respectively. Pharmacy, Agriculture and Teaching are at par (1.25%) while Accounting and Business Administration have 5 and 3.75%, respectively.  Table 5 shows that out of 18 respondents who chose nursing as a career, 15 (83.33%) were females, while 3 (16.67%) were males. Table 6 shows that majority (80%) of respondents made their career choices willingly while 7.50% said they were influenced by role models, 5% were influenced by their parents while 3.75, 2.50 and 1.25% were influenced by school lesson, media (television/internet) and peers respectively. Table 7 reveals that out of 240 respondents, a majority (95%) of respondents were aware of nursing as a career, while 12(5%) of respondents differed on the issue awareness of nursing as a career. Table 8 shows that appreciable number of respondents 41.25% indicated that nursing is School of Nursing/Hospital Based Program while 20% of respondents were affirmative that nursing is studied in the University. 18.75% believed that nursing education is both obtainable at the University and School of Nursing. Five percent indicated that nursing is studied in higher institution while 3.75% indicated that nursing is studied in hospital. 15% of respondents made no response. Table 9 shows that a good number of respondents 53.75% would not consider nursing as career while 46.25% of respondents indicated their inclination toward nursing as a career choice. Table 10 indicates the female gender's higher inclination, (56.76%) than male gender, (43.24%) toward nursing. Table 11 reveals that out of 111 respondents who would consider nursing as a career, majority 67.57% were from the rural    schools, while 32.43% were from the urban area. Table 12 reveals that out of 111 respondents that would consider nursing as a career, majority (81.1%) cited altruism as the reason behind their consideration; while 8.1% indicated interest as the motivation (they just like nursing), 5.4% perceived that nursing is a good discipline, while 5.4% respondents revealed that earning good salary informed their position. Table 13 shows the following; on the statement "nurses are respected and valued", majority 91.25% of respondents agree, while 2.5 and 6.25% of respondents disagree and are undecided respectively; on the statement "Nursing is primarily for women", appreciable number, 47.50% of respondents agree, while 43.75 and 8.75% of respondents disagree and are undecided respectively; on the statement "Nurses care and help others" majority 88.75% of respondents agree, while 2.5 and 8.75% of respondents disagree and are undecided respectively; on the statement "Nurses earn good salary" majority 78.75% of respondents agree, while 5 and 16.25% of respondents disagree and are undecided respectively; on the statement "Nursing is interesting, challenging and offers variety", majority 82.50% of respondents agree, while 17.50% of respondents disagree; on the statement "It takes intelligence to be a nurse", majority 90.00% of respondents agree, while 3.75 and 6.25% of respondents disagree and are undecided respectively. Figure 1 reveals the following; in school A (Urban Public) 40% of respondents would consider nursing as a career while in school B (Urban Private) only 20% of   respondents would consider nursing as a career; in school C (Rural Public) 60% of respondents would consider nursing as a career while in school D (Rural Private) 65% of respondents would consider nursing as a career,

Testing of hypotheses
Three hypotheses were generated in this study and these hypotheses sought to establish relationships between consideration of nursing as a career choice and the following variables; location (setting), gender and school ownership type (that is, private or public) (Tables 14).

DISCUSSION
The following research questions were raised: 1. What is the perception of nursing among secondary Frequency Figure 1. The location, ownership type, and consideration of nursing as a career.   The socio-demographic data shows that the age range of respondents is between 13 to 20years, with the majority, 63.75% of respondents found within the range of 16 to 18years. The finding equally shows that all (100%) respondents have made their career choice. This finding is in line with Knight et al. (2011) which indicated that students often begin investigating career choices and discussing their future plans in middle school. Gavin (2008) also lends support to this finding as his study showed that pupils make career choice about the age of 14years.
The study indicates that 80% of respondents that chose nursing were self-influenced to making a career choice. Thus, this makes personal interest as the most influential factor in making a career choice. This is also supported by Nomonde (2011) in his study of career choice in South Africa. Other influencing factors include; role models (7.5%), parents (5%), school lesson (3.75%), media (2.5%) and friends (1.25%). This agrees with Sawitiri et al. (2012) that found that families, mentors, peers and role model influence career choice among adolescents. The study also revealed that 46.25% of all the respondents were willing to consider nursing in the future, out of which 43.24 and 56.76% are males and females respectively. Hypothesis on this shows that there is no significant relationship between sex, and consideration of nursing as a career choice as indicated by the chi-square analysis. This finding equally shows that choice of careers is tentative thus a lot might still embrace nursing before finally leaving the school. Knight et al. (2011), found in their study that the choice of career is often based on stereotyping instead of awareness of the opportunities. Knight et al. (2011), further discovered that some students, following an after-school workshop, had an increased interest in nursing. There was an increased interest of men who would consider nursing as a career. This is supported by the work of Mkhize and Nzimande (2007) who found that there is an increasing interest among males to pursue nursing. However, this outcome is contradicted by the finding in some other studies which implicated gender as constituting barriers in career decision-making. (Ozdemir et al., 2008).
The choice of nursing by men could be that males have developed an equally positive attitude towards nursing (Law and Arthur, 2003). The respondents generally show a positive perception of nursing as found in Table 13. The majority of respondents, 91.25%, agree that nurses are respected and valued by society. This finds its support in Alexander (2010) in which nurses were seen as valuable members of the healthcare team, providing a valuable service. Also, majority (88.75%) agreed that "nurses care and help others". In a recent study by Jirwe and Rudman (2012), it was revealed that some of the reasons for becoming a nurse include: desire to help people, altruism and work-related motives. Furthermore, majority (78.75%) agreed that "nurses earn good salary". This does not agree with the study of Beggs et al. (2008) that ranked low expected pay as second highest reason for not considering nursing as a career. In addition, majority (82.50%) agreed that "nursing is interesting, challenging and offers varieties". This is in consonance with the study of Brennan et al. (1996) that suggested that student view nursing as a rewarding and challenging profession. The majority (90%) of respondents also agreed that "it takes intelligence to be a nurse". But only an appreciable number (47.50%) agreed that "nursing is a feminine profession". On a general note, respondents had a positive perception of nursing.
The study further revealed that there is no significant relationship between awareness of nursing degree in the university and consideration of nursing as a career choice as evidenced by the result of the tested hypothesis. This finding has its support in Dante et al. (2013) that some students do not choose a nursing degree at matriculation due to their lack of interest, fear of contact with ill/dying people and lack of recognition of nursing work. In addition, the study reveals that there is significant relationship between location of school and consideration of nursing as career choice. That is to say that, urban and rural schools consider nursing as a career choice differently. This finding may be a novel one as the existing literature practically shows dearth of the knowledge of the existence of the association between school location and the choice of nursing. However, one may opine that the values of social support and care may play a significant role in shaping their perception.

Conclusion
This study invariably follows the global patterns as evidenced in the studies on recruitment into nursing with some degree of variations just as its development is moving on different wavelengths across countries hence the contextually-based factors. The import of the findings is that there should be adequate responses from the concerned to improve on the state-of-the art of nursing as the provision of quality care to the different segments of populations may become a mirage if this is not given the proper attention it deserves.

RECOMMENDATIONS
1. Create awareness about nursing among learners from primary schools through to secondary schools using electronic media including edutainment, formal teaching and open days for departments of nursing at tertiary institutions. 2. Market nursing among potential male learners, and demystify the misconception that nursing is a female career. 3. Adequate financially supporting environment should be created for those who are interested in choosing nursing as a career through the provision of special fund, bursaries and scholarships toward enhancing nursing education.

LIMITATIONS OF THE STUDY
1. The study was limited to one geographic area (State) of the country while the locations and schools were purposively chosen 2. Career development spans throughout life, but in this study, only secondary school pupils were considered.