What’s Stopping a Career in Gerontological Nursing? Literature Review ABSTRACT Despite the rapid aging of the world’s population, many countries are experiencing difficulty in recruiting nurses to work with older people. A literature review was conducted regarding the career preferences of undergraduate nursing students from seven dif- ferent countries. The literature review has identified that geron- tological nursing does not feature highly as a career goal. Nota- bly, this has been the situation for the past decade. There is no indication that the situation is going to change at any time in the future unless some serious decisions are made at professional, health service, community, and government levels. This literature review has identified the reasons why undergraduate nurses are not choosing gerontological nursing as a career, what has been done in an attempt to address the problem, and what else may be done. [Journal of Gerontological Nursing, xx(x), xx-xx.] he rapid aging of the world’s population means that the proportion of people ages 60 and older Twill increase from 11% to 22% between 2000 and 2050 (World Health Organization, 2012). In the United States, 41.4 million people are 65 and older, with 24.7% of these individuals rating their health as “fair” or “poor” (Centers for Disease Control and Prevention, 2011). Fur- thermore, 1.3 million of these people live in long-term care (LTC) facilities. The situation is similar in countries with smaller populations such as Australia, where 185,482 older Australians lived in LTC facilities as of June 2011 (Australian Institute of Health and Welfare, 2012). There is concern that the growing population of older adults with associated complex health needs will outpace the number of health workers, such as nurses, with the necessary education and skill to provide competent care (Institute of Medicine [IOM], 2008). As a response to the Francis inquiry of older adult care in the United King- dom (The Mid Staffordshire NHS Foundation Trust, Christine Neville, PhD, RN, FACMHN; Robyn Dickie, RN, BN, McritCN; and Sandra Goetz, RN, MHlthSc, MRCNA Journal of GerontoloGical nursinG • Vol. xx, no. xx, 20xx 1 TABLE 1 STRATEGY FOR LITERATURE SEARCH AND PROCESS OF REJECTION AND ACCEPTANCE OF ARTICLES FOR INCLUSION IN THE LITERATURE REVIEW N Articles Articles Articles Articles that Remaining After Remaining After Retrieved and Fit Inclusion Database Total Articles Title Review Abstract Review Examined Criteria CINAHL 151 15 7 3 1 Medline OVID 74 11 11 11 3 PubMed 168 24 19 13 5 PsycINFO 0 0 0 0 0 Manual search 0 0 0 0 3 Total 393 50 37 27 12 Note. 13 duplicate articles were removed. 2013), The National Health Service, Xiao, 2012; Stevens, 2011; Williams, on LTC facilities given the current together with the Royal College Nowak, & Scobee, 2006). Career employment shortage of nurses in of Physicians, have developed an preferences are often made during this sector. Yielded and reviewed ar- Elder Friendly Ward Quality Mark the time spent as an undergraduate ticles are detailed in Table 1. All au- scheme to recognize the importance student, with many factors influ- thors were involved in the literature of and requirement for competent encing the decision. The aim of this search, study selection, and data ex- health workers to care for older literature review was to examine the traction. Inclusion criteria were both adults (Royal College of Physi- responses of undergraduate nursing qualitative and quantitative studies cians, 2013). Nursing, as one of the students from around the world to- that examined what specialty un- predominant health disciplines, has ward a career in gerontological nurs- dergraduate nursing students were a distinct and important role in ger- ing, the reasons why they are not interested in. Studies were excluded ontology because older adults have choosing gerontology as a graduate if they focused on perceptions or a greater number of hospitalization specialty, what has been done in an attitudes toward older adults gen- days (Gilje, Lacey, & Moore, 2007) attempt to address the problem, and erally as opposed to working with and use the largest portion of health what else may be done. older adults. The authors conducted services (IOM, 2008). The Eldercare a manual search of the reference lists Workforce Alliance (n.d.) stated that METHOD of the 27 retrieved articles to deter- by 2020, the gerontological nursing The search strategy involved mine whether other relevant articles workforce is expected to be 20% be- peer-reviewed, English language, re- fit the inclusion criteria. Three suit- low the projected requirements. Such search studies (2003–current). Data- able studies were extracted using the an alarming projection is a reflection bases included Medline, CINAHL, reference list manual search as out- of the global shortage of nurses (Au- PsycINFO, and PubMed. The lined in Table 1. No other literature erbach, Staiger, Muench, & Buer- search syntax and limiters were aged reviews were found. haus, 2013). However, gerontology care OR nursing homes OR care is at particular risk of RN shortage homes OR residential aged care facil- RESULTS because a career in gerontological ities OR long term care; older adults Two categories of results were nursing is not a desirable option, as OR elders OR elderly OR geriatric* identified: studies that surveyed ca- indicated by undergraduate nursing OR older people; and undergradu- reer preferences and studies that students (Abbey et al., 2006; Bosco, ate nurse OR nursing student OR examined career preferences as an Ward, & Styles, 2005; DeKeyser career OR employment OR jobs. It outcome of a curriculum activity. In Ganz & Kahana, 2006; Henderson, is acknowledged by the authors that most studies, the students provided Xiao, Siegloff, Kelton, & Paterson, students do encounter older people reasons as to why they had limited or 2008; Kloster, Høie, & Skår, 2007; in other parts of the health care sys- no interest in gerontological nursing. McCann, Clark, & Lu, 2010; Shen & tem; however, it was decided to focus The student perspective is important 2 Copyright © SLACK Incorporated TABLE 2 STUDIES OF UNDERGRADUATE NURSING STUDENT CAREER PREFERENCES N (Year of Reasons for Study Country Purpose Method Tool Study) Results Non-Preference Surveys of Career Preferences Shen & Xiao (2012) China Explored factors Cross-sectional Questionnaire 204 (1st year) Working with older Uninspiring career; affecting intention (Stevens & Crouch, 218 (2nd year) adults ranked as lack of confidence to work with older 1998) 123 (3rd year) second to least with older adults; adults. 77 (4th year) preferred area. not technical enough; low pay Rejeh, Heravi- Iran Explored perspec- Qualitative Semi-structured 25 (senior nursing Established two Time constraints; Karimooi, & Vais- tives regarding interviews students) sub-themes: task oriented; poor moradi (2011) caring for older barriers and nurse-patient adults. facilitators to care ratios; too many for older adults. organizational rules; poor environ- mental conditions Stevens (2011) Australia Developed a Longitudinal, Questionnaire 150 (year not Gerontological Negative stereo- profile of career repeated measures (Stevens & Crouch, identified) nursing ranked types; poor clinical preferences and 1998) poorly over 3 placement experi- rationales. years, with de- ences; poor work- creasing interest ing conditions; not from first year. technical enough McCann, Clark, & Australia Surveyed career Longitudinal Attitudes and be- 90 (1st year) Gerontological Media and lay Lu (2010) preference for liefs about mental 46 (2nd year) nursing ranked image poorly specialty areas. health problems: 96 (3rd year) consistently over presented; limited Professional and 3 years as least theoretical and Public Views ques- preferred career clinical experience tionnaire (Jorm, choice. with older adults; Korten, Jacomb, limited contact Christensen, & with gerontologi- Henderson, 1999) cal academics Henderson, Xiao, Australia Explored the inten- Cross-sectional Questionnaire 262 (1st year) Gerontological Lack of inter- Siegloff, Kelton, & tions for practice (Stevens & Crouch, nursing least pre- est; physically Paterson (2008) and attitudes to- 1998) ferred work option; demanding; fear ward older adults. those with previ- of suffering and ous experience in dying; negative the industry more experiences and likely to want a interactions with career in geronto- older adults logical nursing. 3 Journal of GerontoloGical nursinG • Vol. xx, no. xx, 20xx 4 TABLE 2 (CONTINUED) STUDIES OF UNDERGRADUATE NURSING STUDENT CAREER PREFERENCES N (Year of Reasons for Study Country Purpose Method Tool Study) Results Non-Preference Kloster, Høie, & Norway Identified career Longitudinal Study-specific 620 (1st year) Gerontological Not challeng- Skår (2007) preferences. questionnaire 473 (3rd year) nursing ranked ing; boring; poorly as a prefer- heavy workload; ence for future lacked resources; work at both the inadequate staff beginning and levels; unqualified end of studies and workers ranked 2nd as a place students did not want to work at the end of their studies. DeKeyser Ganz & Israel Determined the Longitudinal Study-specific 178 (1st, 3rd, & 4th Gerontological Not interesting; Kahana (2006) perceptions of questionnaire years) nursing recognized lacked prestige nursing students as a high social toward specialties need, but ranked and what factors last in categories, influence these. social prestige, in- terest, and choice of workplace. Bosco, Ward, & Australia Determined