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Young peoples' perceptions of the nursing

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DOI: 10.1016/j.nedt.2017.07.008

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 Nurse Education Today 57 (2017) 95–102

Contents lists available at ScienceDirect

Nurse Education Today

journal homepage: www.elsevier.com/locate/nedt

Review

Young peoples' perceptions of the nursing profession: An integrative MARK

review☆
Niina Glereana,⁎, Maija Huplia, Kirsi Talmana, Elina Haavistob
a
Department of Nursing Science, University of Turku, 20014, Finland
b
Department of Nursing Science, Hospital District of Satakunta, University of Turku, 20014, Finland

A R T I C L E I N F O A B S T R A C T

Keywords: Objectives: The purpose of this integrative review was to describe young people's perceptions of the nursing
Nursing profession profession and to identify factors influencing the perception.
Perception Design: Integrative literature review.
Career choice Data Sources: The CINAHL, PubMed and Medic electronic databases were searched for research publications
Nurse image
between 2006 and 2016. The keywords used were: perception, attitude, belief, view, knowledge, image, nurse,
Young people
nursing care, career, profession, role, teen, middle school student, high school student, adolescent and pupil. A
manual search was conducted of the reference lists of the identified articles.
Review Methods: Whittemore and Knafl's method for conducting an integrative review was utilized. The quality
of the chosen articles was assessed with Joanna Briggs Institute's quality appraisal tools.
Findings: The search resulted in eight articles. Young people described the nature of nursing work with poor
working conditions, shift work and a limited level of autonomy. Nursing work was mainly seen as caring for and
helping patients which was considered inferior to doctors' work. Young people did not recognize the educational
requirements or the career pathways in nursing and described the status of nursing as low in society. Nurses were
considered as kind and caring people who work hard and are less intellectual. The factors influencing the
perception were family and relatives, friends, media, significant others and personal factors.
Conclusions: Perceptions of young people do not reflect the reality of the nursing profession and the perceived
image of nursing has not changed in the last ten years. Young people and the public need realistic information of
the nursing profession and the actions to change the image should take place at all levels of the society. Further
research is needed to understand how the perceptions of the young people can be influenced and changed to
reflect a more realistic image of a contemporary nurse.

1. Introduction
Young people's perceptions of the nursing profession guide the
choice of a career in nursing (Hemsley-Brown and Foskett, 1999;
Buchan and Seccombe, 2010; Brodie et al., 2004). The concept of
perception has been defined as a mental image (Merriam-Webster,
2016a; Merriam-Webster, 2016b) or interpretation of something, that
one creates through knowledge, experiences, attitudes and beliefs
(Oxford Dictionaries, 2016).
Furthermore, according to the self-perception theory people's ac-
tions are often socially influenced (Bem, 1972). The perception can
influence young people's career choices (Brodie et al., 2004), retain-
ment in the education (Harvey and McMurray, 1997), and retention in
the nursing profession (Başkale and Serçekuş, 2015). Therefore, to
retain motivated and skilled young people in the nursing profession, it
is essential that they have a realistic perception of the nursing profes-
sion. Career choice is also closely connected with the concept of pro-
fessional identity, which, for example, refers to acquisition and de-
monstration of knowledge of the profession (Slay and Smith, 2011).
Professional identity is also related to the historical notion of the status
of different professions (i.e. social value) (Health and Care Professions
Council, 2014) which may have an effect in the career choice.
Nurses form the largest professional group in health care and they
have a central role in delivering and strengthening the services. In re-
cent years, nursing shortage has been reported as a global challenge
(WHO, 2016a). In addition, the shortage of nurses has been predicted to
grow and by the year 2020 there will be a need for 590,000 new nurses
in Europe (Sermeus and Bruyneel, 2010) and by the year 2030 a need of

☆
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
⁎
Corresponding author.
E-mail addresses: niergl@utu.fi (N. Glerean), maija.hupli@utu.fi (M. Hupli), kimata@utu.fi (K. Talman), elina.haavisto@utu.fi (E. Haavisto).

http://dx.doi.org/10.1016/j.nedt.2017.07.008
Received 31 January 2017; Received in revised form 20 June 2017; Accepted 12 July 2017
0260-6917/ © 2017 Elsevier Ltd. All rights reserved.
N. Glerean et al.
9 million new nurses globally (WHO, 2016b). The phenomenon is often
described as a demand and a supply problem. The need for nurses is
increasing because of the growing and demanding needs of the aging
populations, but also because of the aging and retiring workforce.
Moreover, insufficient staffing leads to job dissatisfaction and a growing
turnover rate of qualified nurses (AACN, 2014) especially among the
young workforce (Flinkman, 2014). Simultaneously, low enrollment
rates (AACN, 2014) and increasing attrition rates are causing concern
for nursing schools (Stewart et al., 2006; Fraher et al., 2009; Rankin,
2013). The dropout rates of nursing students range from 25% in the UK
up to 40% in Canada increasing costs and wasting scarce resources in
nursing education (Salamonson et al., 2014).
The perception of the nursing profession is influenced by the public
image of nursing (Milisen et al., 2010), which has been recognized to
portray nurses in a stereotypical and negative way, presenting nursing
as inferior to medicine (Price et al., 2013). The young peoples' per-
ceptions of the nursing profession have been studied for decades, but
the studies focus mainly on nursing students (Weaver et al., 2013; Er
et al., 2015) and the change in perception of the profession during
nursing education (Bolan and Grainger, 2009; Safadi et al., 2011). Some
studies also exist about school pupils' perceptions of the nursing pro-
fession (Neilson and Lauder, 2008; Beattie et al., 2014). However, little
is known about the perceptions of the young people who are choosing a
career. More information is needed to understand how they perceive
the nursing profession and the factors influencing their perception.
Therefore, to describe the topic comprehensively, an integrative review
of the existing literature needs to be conducted to direct future studies
in this research area.
2. Purpose and Questions
2.1. Purpose of the study
The purpose of this integrative review was to describe young peo-
ple's perceptions of the nursing profession and to identify factors in-
fluencing the perception.
2.2. Research Questions
(1) What kind of perceptions do young people have on the nursing
profession?
(2) What factors influence young people's perceptions of the nursing
profession?
This study is part of the larger Reforming Student Selections in
Nursing Education (ReSSNE) project which aims to produce a national
and reliable student selection method for Finnish nursing education.
3. Method
An integrated review method was chosen because it allows the use
of studies with different research methodologies in the review to gen-
erate a comprehensive understanding of the phenomenon under study
(Whittemore and Knafl, 2005; Cooper, 1989). The review was con-
ducted by following the Whittemore and Knafl (2005) process for
conducting an integrated review. The process includes the following
phases: 1) problem identification, 2) literature search, 3) data evalua-
tion, 4) data analysis, and 5) presentation of the results.
3.1. Literature Search
In this study, a systematic literature search was made in three da-
tabases: PubMed, Cinahl and Medine Ovid. The search was undertaken
in October 2016 by using a combination of the following keywords:
perception, attitude, belief, view, nurse, nursing care, career, profes-
sion, role, teen, middle school student, high school student, adolescent,
96
Nurse Education Today 57 (2017) 95–102
and pupil. To focus on the most recent publications, the search was
limited to articles published between the years 2006–2016. The search
was also limited to research articles that had an abstract available and
were written in English.
Young people were defined as people between the ages 15 to 24,
which follows the United Nations' definition for young people(United
Nations, n.d). Articles were included in the review if the topic was
about perceptions of the nursing profession of young people aged
15–24 years. Thus, articles with study populations under 15 years or
over 24 years were excluded. Articles describing the perceptions of
nurse students or graduated nurses or the public image of nursing or the
nurse image in the media were also excluded from the review, as were
articles about the influence of significant others, the influence of work
experience and instrument development to measure young peoples'
perceptions of nursing. Moreover, literature reviews were excluded
from this review.
3.2. Description of the Studies
The database search identified 4705 articles: PubMed 2041,
CINAHL 238 and Medline Ovid 2426. After screening the titles and
removing duplicates, 24 articles remained, 17 of which were excluded
based on the abstracts. Thus, seven articles were selected for the review.
An additional two articles were selected based on a manual search of
the reference lists of the included articles. One article was excluded
because the full text was not available. Finally, 8 articles were selected
for the review (Fig. 1)(Moher et al., 2009). The literature search and the
screening of the articles was undertaken by the first author (N.G.) and
verified by a co-author (K.T.).
Four of the chosen articles were from the USA, two from the UK and
one from Italy. Additionally, one study was conducted in two countries
(Israel and USA). The study designs of the chosen articles were quali-
tative (Norman, 2015), quantitative (Seago et al., 2006; Palumbo et al.,
2008; Whitehead et al., 2007; Dante et al., 2013; Degazon et al., 2015)
and interventional studies (Yeager and Cheever, 2007; Katz, 2007). The
data collection methods used were surveys (Seago et al., 2006; Katz,
2007; Yeager and Cheever, 2007; Whitehead et al., 2007; Palumbo
et al., 2008; Dante et al., 2013; Degazon et al., 2015) and an interview
(Norman, 2015). The study subjects were adolescents, high school and
college students (Table 1). From the interventional studies, only the
data collected before the intervention were retrieved, because the in-
terventions might have influenced the perceptions of the studied
sample.
3.3. Quality Appraisal of the Chosen Studies
In integrative reviews, it is essential to evaluate the quality of the
primary sources (Cooper, 1998; Whittemore and Knafl, 2005). In this
review, the quality of the chosen articles was assessed with two Joanna
Briggs Institute (JBI) quality appraisal tools. The Checklist for Analy-
tical Cross Sectional Studies was used for quantitative studies, including
interventional studies in which only the pre-intervention data were
included (JBI, 2016b). The Checklist for Qualitative Research was used
for a qualitative study (JBI, 2016a). Two researchers (N.G. & K.T.)
conducted the quality appraisal independently and consensus was
reached based on discussion. The criteria were discussed in detail be-
tween the two researchers to avoid misinterpretations.
Quality appraisal showed variation in the quality of the chosen ar-
ticles but none of the articles were excluded because the aim was to
review literature broadly. However, the quality appraisal of the chosen
articles enhances the accuracy of the results in drawing conclusions of
this article (Whittemore and Knafl, 2005) (Table 2).
3.4. Data Analysis
The data analysis process started with logical data reduction
N. Glerean et al.
(Whittemore and Knafl, 2005). In this study, the data reduction was
done by identifying young people's perceptions of the nursing profes-
sion from the articles. The perceptions identified were collected on a
spreadsheet for further analysis. After this stage, the codes were com-
pared and identified as sub-categories. These sub-categories were then
analysed and synthesized as main categories. The same data analysis
process was conducted to find the factors that influenced young peo-
ple's perception of the nursing profession (Miles and Huberman, 1994,
Whittemore and Knafl, 2005). The data analysis process was under-
taken by the first author (N.G.) and discussed and verified in the re-
search group (M.H. & E.H.).
4. Findings
4.1. Young People's Perception of Nursing Profession
In this integrative literature review, young people's perception of
the nursing profession was described through the following categories:
1) the nature of nursing work, 2) contents of nursing work, 3) re-
quirements of nursing work and profession, 4) nursing as a career
choice, and 5) characteristics of a nurse.
4.1.1. The Nature of Nursing Work
The nature of nursing work was described considering nurses'
working conditions, working times and level of autonomy in the nur-
sing profession. Young people recognized the working conditions of a
nurse as poor. Furthermore, nursing was described as a hard, stressful
and busy occupation with a high risk of injury and with working times
with limited flexibility. In addition, the lack of autonomy was asso-
ciated with the nursing profession also on a more general level: nurses
are not independent, not making decisions for themselves and the job
does not have enough flexibility (Seago et al., 2006, Whitehead et al.,
2007, Palumbo et al., 2008; Degazon et al., 2015; Norman, 2015).
97
Nurse Education Today 57 (2017) 95–102
Fig. 1. PRISMA flow diagram of the study selection.
4.1.2. Contents of Nursing Work
Young peoples' perception of the content of nursing work included
patient care, working with technology and nurses being doctors' assis-
tants. Patient care was described through the caring and helping role of
a nurse. Nurses were portrayed as working with patients and being in
contact with illness, death and biological materials. Besides patient
work, nurses were recognized to work with technology and have an
assisting role to doctors (Yeager and Cheever, 2007; Whitehead et al.,
2007; Palumbo et al., 2008; Dante et al., 2013; Degazon et al., 2015;
Norman, 2015).
4.1.3. Requirements of Nursing Profession
Young people identified personal interest and educational require-
ments as requirements of the nursing profession. The personal interest
in nursing varied and although the nursing profession was described as
interesting, it was also considered as not appealing. The educational
requirements of the nursing profession were expressed as non-academic
and the length of the nursing education was acknowledged to be too
long. Also, lack of awareness of the qualification requirements of nur-
sing was reported: in the study by Dante et al. (2013), more than one
third of the participants were not sure whether any qualification is
needed (Seago et al., 2006; Whitehead et al., 2007; Dante et al., 2013;
Degazon et al., 2015; Norman, 2015).
4.1.4. Nursing as a Career Choice
Young people's perception of nursing as a career choice was de-
scribed through the progression opportunities in nursing, job security,
salary and the status of the nursing profession in society. Progression
opportunities were considered to be limited with restricted opportu-
nities in management and leadership. In Yeager and Cheever's (2007)
study, young people recognized the possibilities in leadership, even
though surprisingly, the leadership positions in nursing were seen as a
negative factor. Young people considered nursing as a secure job. The
perception of nurses' salary varied from low pay to good income
 Table 1
Description of the chosen studies.
N. Glerean et al.

Study Purpose of the study Sample Data collection method Analysis methods

Seago et al. (2006) To determine if college students had different perceptions of a 3253 college students Survey instrument: self made ANOVA across the four occupation groups with Scheffe's method for
USA career in nursing, medicine, physical therapy, and high school (average age 25) post-hoc correction; Chi-square test for comparing nurse majors versus
teaching. To compare the perceptions between the non-nurse Non-nurse majors didn't all others, with significance threshold at p < 0.01.
majors and the nurse majors. take any nursing courses
yet
Katz (2007) To determine changes in native American high school students' 17 high school students Survey instrument: pre and post test survey, Descriptive statistic measures of frequency, central tendency, and
USA knowledge and opinions about nursing after attending a 6-day (aged 15–18) investigator constructed variability.
residential summer nursing institute that provided information Pre and post test survey differences were analysed with paired t-test,
of nursing profession. Only pretest data was analysed in this study Wilcoxon sign rank test and McNemar test.
Cronbach's alpha.
Significance threshold at p < 0.05, no correction for the multiple
comparisons.
Yeager and Cheever To determine whether attending a residential nursing camp 96 adolescents (aged Survey instrument: investigator constructed 2 Descriptive statistics: mean, standard deviation, and frequency
(2007) program influenced adolescents' attitudes towards nursing 14–18) surveys, only one was used distribution
USA careers. Paired sample t-tests
Significance threshold at p < 0.05, no correction for the multiple
comparisons.
Whitehead et al. To identify the factors that negatively and positively influence 106 high school students Survey instrument: self made Descriptive statistics (frequencies, percentages and categorical data)
(2007) the career choice of not entering the nursing profession and (aged 16 or over). Qualitative content analysis; Miles and Huberman (1994)
UK entering the nursing education.

Mixed method To identify any cultural differences that positively and

negatively impact on the decision to choose a career in nursing.

98
Use the results to develop follow-up research and make available
the findings for recruitment policy.
Palumbo et al. To compare and contrast young adults' perceptions of an ideal 720 young people of which Survey instrument: perceptions of an ideal Descriptive statistics Wilcoxon signed rank test and paired t-test,
(2008) career versus their perceptions of six health professions: medical 117 considered nursing career and health care career; May et al. Significance threshold at p < 0.0028 (Bonferroni corrected for the
USA laboratory science, nursing pharmacy, physical therapy, (aged 18–24) (1991) — modified version multiple comparisons)
radiation technology and respiratory therapy.
Dante et al. (2013) To describe the reasons why students about to start university 507 university students Survey instrument: self made Descriptive statistics
Italy did not choose a nursing degree, the source of information/data (aged 17–22) Chi-square test (Fisher when appropriate)
on which they based this decision on and the accuracy of this Significance threshold at p < 0.05, no correction for the multiple
information with regard to the nursing profession in Italy. comparisons.
Degazon et al. To compare ethnic minority high school students in the USA and 330 high school students Survey instrument: Attitudes, Values, and The Mann–Whitney U test to compare USA vs Israeli students'
(2015) in Israel on their perceptions of nursing as a career, and to (aged 14–18) Beliefs Questionnaire developed by May et al. perception of nursing
USA/Israel understand how those perceptions compare to their perceptions (1991) Two-sided Wilcoxon signed ranks test to compare ideal career versus
of an ideal career. nursing career.
Spearman correlation to test for association between nursing career
and personal factors.
Significance threshold at p < 0.05, no correction for the multiple
comparisons.
Norman (2015) To describe what perceptions do year 11 pupils have of nursing 40 adolescents (aged Semi-structured interviews Phenomenological qualitative analysis
UK and in what ways do these perceptions of nursing reflect the 15–16)
discourse(s) within and about the nursing profession, and what
role does policy and the media play in this process? What
experiences may have influenced their perceptions of nursing as
a career and what other factors have impacted on year 11 pupils'
perceptions of nursing?
Nurse Education Today 57 (2017) 95–102
 N. Glerean et al.

Table 2
The quality appraisal of the chosen studies.

Checklist for analytical cross sectional Seago et al. Katz Whitehead et al. Yeager and Palumbo et al. Dante et al. Degazon et al. Checklist for qualitative research Norman
study (2006) (2007) (2007) Cheever (2007) (2008) (2013) (2015) Joanna Briggs Institute (2015)
Joanna Briggs Institute

1. Were the criteria for inclusion in the U Y Y Y N Y Y 1. Is there congruity between the stated philosophical Y
sample clearly defined? perspective and the research methodology?
2. Were the study subjects and the U Y Y Y Y Y Y 2. Is there congruity between the research methodology Y
setting described in detail? and the research question or objectives?
3. Was the exposure measured in a valid U Y N N Y Y U 3. Is there congruity between the research methodology Y
and reliable way?a and the methods used to collect the data
4. Were objective, standard criteria used N Y U U Y Y Y 4. Is there congruity between the research methodology Y
for measurement of the condition?b and the representation and the analysis of the data?
5. Were confounding factors identified?c N N N N N N N 5. Is there congruity between the research methodology Y
and interpretation of the results?

99
6. Were strategies to deal with N N N N N N N 6. Is there a statement locating the researcher culturally or N
confounding factors stated?c theoretically?
7. Were the outcomes measured in a N UN Y Y Y U Y 7. Is there an influence of the researcher on the research N
valid and reliable way? and vice versa addressed?
8. Was appropriate statistical analysis Y Y N U Y Y Y 8. Are participants and their voices adequately Y
used? represented?
9. Is the research ethical according to current criteria or for Y
recent studies, and is there evidence of ethical approval by
an appropriate body?
10. Do the conclusions drawn in the research report flow Y
from the analysis, or interpretation of the data?

Legend: Y = yes, N = no, U = unclear, NA = not applicable.

a
Required: face validity and pilot test or Cronbach's alpha.
b
Required: baseline characteristics of the studied sample listed.
c
Required: confounding factors clearly mentioned.
Nurse Education Today 57 (2017) 95–102
N. Glerean et al.
Fig. 2. Young people's perception of nursing profession.
potential, though unawareness of the salary amount was also reported.
Moreover, the status of the nursing profession in society was considered
low. Paradoxically, young people considered nursing to be meaningful
work and nurses to be needed and respected, although the nursing
profession was at the same time reported to have low prestige and low
status in society. Nursing was also considered to be a feminine job,
suitable for women (Seago et al., 2006; Yeager and Cheever, 2007;
Whitehead et al., 2007, Palumbo et al., 2008; Dante et al., 2013;
Degazon et al., 2015; Norman, 2015).
4.1.5. Characteristics of a Nurse
Young people described nurses through their personal and physical
qualities and skills. Nurses were considered to be kind, caring and
helpful as well as understanding, reliable and open-minded persons
who work hard and are determined although less intellectually able.
Nurses were considered to be physically strong and to have good social
skills, be able to stand the sight of blood and be able to cope with death
(Whitehead et al., 2007; Norman, 2015) (Fig. 2).
4.2. Factors Influencing Young People's Perceptions of the Nursing
Profession
Altogether five factors influencing young people's perceptions of the
nursing profession were identified: 1) relatives, 2) friends, 3) other
significant people, 4) media, and 5) personal factors (Fig. 3).
4.2.1. Family and Relatives
Family members have a strong influence on young people's career
choice.
Fig. 3. Young people's perception of nursing profession.
100
Nurse Education Today 57 (2017) 95–102
Parental support and the information given about the nursing pro-
fession were seen to influence young peoples' perceptions. Especially
mothers' and grandmothers' influence on choosing nursing was re-
cognized. High education in the family and a family member working as
a nurse had a negative influence on young people's perceptions of
nursing (Katz, 2007; Whitehead et al., 2007; Dante et al., 2013 Degazon
et al., 2015; Norman, 2015).
4.2.2. Friends
Young people recognized friends as a source of information that can
potentially influence their career decisions. However, knowing a nurse
did not make young people more likely to choose nursing. Furthermore,
knowing a nurse correlated negatively with the perception of nursing
(Katz, 2007; Whitehead et al., 2007; Dante et al., 2013, Degazon et al.,
2015).
4.2.3. Media
Media, such as the Internet and hospital TV dramas, are a source of
information for young people and influence their perceptions of nur-
sing. The presented nurse image does not encourage them to pursue a
nursing career (Whitehead et al., 2007, Dante et al., 2013, Norman,
2015).
4.2.4. Significant Others
The role of the significant others was discussed in only one article.
The significant others, who might have an influence on young peoples'
career choice, are teachers and career services (Whitehead et al., 2007).
N. Glerean et al.
4.2.5. Personal Factors
Personal factors, such as interest in nursing, personal experiences,
gender, and success in studies, have an influence on young people's
perception of nursing. Young people were reported being aware of the
nursing profession through their own interests and experiences.
Females were considered better suited for the nursing profession and
were also more likely to consider nursing as a career choice.
Furthermore, success in studies was stated to be meaningful: high GPA
correlated negatively with young people's perception of nursing (Seago
et al., 2006; Whitehead et al., 2007; Dante et al., 2013; Degazon et al.,
2015; Norman, 2015).
5. Discussion
5.1. Main Findings
One of the main findings of this review is that young people's per-
ception of the nursing profession has not changed over the last ten
years. Nursing continues to be seen as a virtuous caregiving profession
for females, often forgetting the wide need for knowledge, skills and
expertise required in the occupation (Grossman et al., 1989; Kohler and
Edwards, 1990; Hemsley-Brown and Foskett, 1999; Palumbo et al.,
2008; Cohen et al., 2004). Even though, the desire to care for people is
often named as the main reason to pursue a career in nursing (Usher
et al., 2013; Halperin and Mashiach-Eizenberg, 2014), the one-sided
image of the profession seems to be leaving out a large number of po-
tential nursing school applicants (Price et al., 2013), such as high-
achieving gifted young people (Neilson and Lauder, 2008; Miller and
Cummings, 2009) or males (Zamanzadeh et al., 2013).
According to the results of this review, young people's perceptions
of the nursing profession are socially influenced, which supports Bem's
(1972) self-perception theory. In addition, the influencing factors stated
in this integrated review are supported by earlier studies. Family plays
an important role in the career choice of young people (Borycki and
Samuel, 2001), and the educational level and financial situation in the
family have in particular been connected to young people's likeliness to
choose nursing as a career (May et al., 1991; Borycki and Samuel,
2001). The important role of friends in developing perceptions is also
evident from the earlier literature (Mooney et al., 2008). Furthermore,
the influence of teachers and career advisors on career choices and the
perception of nursing has also been previously recognized in the lit-
erature (Cohen et al., 2004). Career advisors' information to young
people on the nursing profession has been stated to be outdated and
negative (Neilson and McNally, 2013). These negative perceptions to-
wards the nursing profession have made young people less likely to
choose a career in nursing (Neilson and Jones, 2012).
The status of the nursing profession in society has been linked to the
recruitment and retention of nurses (Cabaniss, 2011). In particular, the
image of a nurse presented in the media has an impact on the recruit-
ment of new nurses (Kalisch et al., 2007). In this literature review, the
media influence on the perception was recognized, and especially
hospital dramas were stated to have a negative influence on the per-
ceptions. The stereotypical way of presenting nursing in the media was
already recognized in the 1990s (Bridges, 1990) and it has not changed
much in the past years (Neilson and Lauder, 2008; Kelly et al., 2012;
Weaver et al., 2013). The media influence on young people's lives might
be growing in the future as the z-generation youngsters have been es-
timated to be more exposed to media than any other generation before
(Shatto and Erwin, 2016).
The need to replace the incorrect and old-fashioned image of nur-
sing with a more realistic and versatile one has been recognized in the
literature (Price et al., 2013) and there have been several attempts to
improve the image of nursing, such as recruitment campaigns (Johnson
and Johnson, 2017) and educational interventions like summer camps
(Hoke, 2006). However, according to the results of this review, these
attempts have not affected young people's perception. More actions to
101
Nurse Education Today 57 (2017) 95–102
influence their attitudes, beliefs and knowledge about the nursing
profession is needed in all levels of society to change their perceptions.
In addition, more realistic and detailed information of the actual nur-
sing work should be given to prevent the misperceptions guiding the
career decisions of undecided young people. The recruitment cam-
paigns should be targeted not only towards young people, but also to
their parents and to the public to raise awareness and create positive
perceptions of the nursing profession. Nursing schools are also a key
agent in creating accurate and positive images. Nursing schools should
take a more active role in society in sharing information and educating
the community to create a contemporary image of nursing, which might
eventually also influence young people's perceptions. Active use of so-
cial media, such as Twitter and Facebook, should be considered in
raising the visibility of the nursing profession and sharing information.
Also, closer co-operation with career advisors and high schools should
be emphasised.
5.2. Limitations of the Study
There are some limitations to be considered in this review. Firstly,
the data search was limited to the English language due to a resourcing
of the review, and therefore some relevant articles may not have been
identified. Secondly, the articles chosen for the review were mainly
limited to quantitative survey, which makes it difficult to describe the
topic comprehensively. Thirdly, the quality of the chosen studies
varied. The quality appraisal demonstrated some weaknesses in the
study designs, samples and in the methods. However, all the selected
articles were included in the review because of the limited amount of
research conducted.
Because of the limitations, the generalizability of the findings can be
limited. However, this integrative literature review underlines the need
for up to date studies concerning the perceptions of young people about
the nursing profession to not only describe and understand the per-
ception but also to create an updated image of nursing that is appealing
to young people also in the future.
6. Conclusions
The perception of young people about the nursing profession re-
peats the historical image of a nurse as a caring and helping and al-
truistic woman. The profession's independence, versatile roles and
complex tasks and the academic career opportunities of a nurse are not
recognized. In this literature review, the nursing profession was often
described from the career choice perspective and an understanding of
the contents of nursing work among young people still remains unclear.
In the future, more studies are needed to explore young people's
perception of the nursing profession. Further research is needed to
understand how these perceptions can be influenced and changed to
reflect a more accurate image of a contemporary nurse. False percep-
tions have an influence on student retention in the nursing schools, and
therefore, the evaluation of nursing applicants' perceptions in the stu-
dent selection process might lead to greater student retention.
Author Contribution
Study design: N.G., K.T., M.H. & E.H.
Data collection: N.G. & K.T.
Data analysis and interpretation: N.G., M.H. & E.H.
Writing the manuscript: N.G. & K.T.
Drafting the manuscript and supervision: M.H. & E.H.
Critical revision of the article: N.G., M.H., K.T. & E.H.
Acknowledgements
We would like to thank Enrico Glerean for comments on the
manuscript.
N. Glerean et al.
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