Registered nurses' perceptions of their career—An interview study

Abstract Aim We aim to explore registered nurses' perceptions of their career. Background Career development options have been found to increase attraction to nursing and support nurses' engagement with their organization and profession. Methods We collected qualitative individual interviews with 23 registered nurses; data were analysed with thematic analysis and reported according to the consolidated criteria for reporting qualitative research (COREQ) criteria. Results Three themes emerged: career choices, career engagement and career development. Participants had chosen a nursing career because they perceived it as humane, people oriented, meaningful, diverse and secure work. Participants' engagement in their career was connected to the content of the work, in which direct patient care was central. Nurses connected career development with high competency, independence, influence and meaningful working life experience. However, they perceived career development opportunities as minute within direct patient care. Conclusions Career development opportunities for nurses in direct patient care are needed to foster their career engagement and the attractiveness of the nursing profession. Further research is needed on the career planning and development of nurses working in patient care. Implications for Nursing Management Nurse managers must play a central role in engaging nurses in their careers and promoting their competency and career planning and development in organizations.

to provide such care. However, several deficiencies have been recognized that hinder nurses' motivation to engage in their career: excessive workload (Kox et al., 2020) and underpay (Bayliss-Pratt et al., 2020) in particular.
Nursing has been a traditional 'calling profession', often referred to altruistic and sacrificing image of a nurse as an unambitious subordinate, thus conflicting with career pursuits (Meleis, 1997). However, previous research has shown that high competency and training opportunities are important for nurses' experience of meaningful careers and ability to provide high-quality care (Hariyati et al., 2017) in a burdensome, constantly changing health care environment (Price & Reichert, 2017). Research has also addressed the fact that nurses value autonomy in their work (Rakhab et al., 2021) and that, as they work closely with patients, they play a vital role in developing care practices (Kallio et al., 2018). Furthermore, it is notable that younger generations have been shown more likely to base their career choices on financial comfort rather than living a calling with poor pay (Carter, 2014).
Opportunities for career development have been recognized to resonate with nurses' experience of a meaningful working life (Moore et al., 2019) and to be one of the key factors in workforce retention (Brook et al., 2019;Marufu et al., 2021;Yarbrough et al., 2017). However, factors supporting career development (Eley et al., 2012;Marufu et al., 2021), such as clear progression routes (Rakhab et al., 2021) and advocacy by leadership (Price & Reichert, 2017), have often been found lacking. Research describing registered nurses' perceptions of their careers is scarce. We aimed to provide such knowledge. This knowledge will be beneficial for nurse managers to support nurses in their career planning and is needed from the perspective of competence management and future competence needs.

| Study design, participants and recruitment
This was a descriptive qualitative study with individual semistructured interviews for Finnish registered nurses conducted in March 2021. Participants were recruited from care workers' trade unions within a research project with a survey in which respondents (n = 7925) were informed about an opportunity to enrol in interviews.
Altogether, 403 care workers volunteered, and of those, 64 were registered nurses. To form a reasonable but sufficient group of participants to answer the research question (Polit & Beck, 2010), we decided to invite all the nurses who were members of one nurses' union (n = 34). Finally, 23 nurses (Table 1) were interviewed, including the three pilot test interviews. The amount of participants was assessed to be purposeful due to the saturation, which emerged as an accumulation of participants' repeated parallel perceptions regarding the interview guide themes (Polit & Beck, 2010). We have followed the consolidated criteria for reporting qualitative research (COREQ) checklist (Tong et al., 2007; Table S1) for reporting.

| Data collection
We collected data with semi-structured individual interviews to allow participants broadly describe their perceptions within the topic of nurses' career and calling. We developed the interview guide to provide a uniform skeleton for the interviews (Kallio et al., 2016). Based on previous research (e.g. Carter, 2014), we formulated three main themes with follow-up questions that focused on nurses' career and calling. We pilot tested the guide with three randomly selected registered nurses. Based on the pilot test, we revised expressions to make the questions more practical and understandable (Table S2)

| Analysis
The analysis method was data-driven thematic analysis to provide a rich and diverse description of the data (Braun &  Hospital (n = 2) a 9 Health centre, home care (n = 1) a 7 Nursing home 3 Foundation 2 Other than health sector 2 Other profession in health field n = 13 Primary nurse 9 Public health nurse 2 Housekeeper 2 a Included pilot test participants (N = 3). Clarke, 2006). Recordings were transcribed, producing 309 pages of text (Calibri 12, single-spaced). After becoming familiar with the transcripts, the researcher (H. K.) coded and collated the data to sub and main themes using NVivo 12 software (Braun & Clarke, 2006). The initial analysis was discussed, refined and finalized by the research team.

| Ethics
Ethical principles were followed throughout the research process (ALLEA, 2017

| Content of work
The content of the work had a central influence on nurses' career engagement. Direct patient care was important; nurses found it rewarding to be able to help patients, see them recover and receive positive feedback from them. Nurses also emphasized the importance of abundantly challenging and versatile work, meaning that narrow and repetitive work tasks were insufficient. They also brought up that it is important to work in a field and work environment suitable to one's personal interests. One issue that participants considered to be motivating was development possibilities as part of their work so that the problems they encountered were solved and they could be part of this process.

| DISCUSSION
Based on this study, a nursing career with direct patient care was desirable. Nurses had chosen their career because of the people oriented and humane nature of nursing, the element that appears to be persistent over time (Carter, 2014;Eley et al., 2012). Throughout their working lives, patient care and practice tended to remain crucial for nurses' experience of a meaningful career. However, nurses perceived career opportunities, models and support within direct patient care to be lacking. Instead, they connected career development in nursing to moving away from patients. In addition, they experienced a lack of societal support for and valuation of a nursing career. It is worth noticing that it may be beneficial in the longer term to also encourage those nurses who are uninterested in career development because they want to stay in their current role. Research has shown that in the longer term, extending the boundaries of practice may lead to increased autonomy and responsibilities and promote confidence and empowerment (Rasmussen et al., 2018) as well as engagement (Arrowsmith et al., 2016). Overall, professional advancement activities have been proven to promote retention of nursing staff and reduce turnover (Brook et al., 2019); however, activities are not widely used for these purposes, as our results showed.
Nurses in this study considered nursing as a career to be somewhat dull. Nurses expressed their interest towards career development and connected it to meaningful work but saw their opportunities for it as scarce, even non-existent. If a nurse were to proceed in a career, it meant abandoning direct patient care, the element that made them to choose the career and gave its meaning (Karlsson et al., 2019). Weak career development possibilities may lead to decreased job satisfaction and leaving the profession (Zhu et al., 2021). Therefore, health care organizations should develop career paths that allow patient care practice throughout the career to that could prevent nurses from being frustrated and leaving the profession and instead foster professional identity (Rasmussen et al., 2018).
Another challenge in career advancement in nursing is that employers had supported nurses' career development very little (also Price & Reichert, 2017 (Tucker & Gallagher-Ford, 2019) and nurse managers' role in strengthening nurses' career planning and introducing them possible career goals already at the beginning of their careers (Yan et al., 2021). Some leadership styles have been shown to be beneficial to nurses' careers and are therefore worth taking into account in nurse managers' degree programmes and continuing education. For example, an authentic leadership style has been shown to increase nurses' career satisfaction, decrease career turnover intentions (Alilyyani et al., 2018) and servant leadership professional development (James et al., 2021).
Nurse managers, but also nurses themselves from the very beginning of their nursing career, should be aware of career development opportunities and possibilities, because a successful career needs planning and networking (Carter, 2014). Thus, scrutinizing nurses' career development thoughts, wishes and ideas and opportunities to answer them is an important part of development discussions and regular updates between an employee and a supervisor and degree education in nursing. The nurse managers' role is also central in making the organization's career path models familiar to nurses (Moore et al., 2019).
Lack of career development programmes also seems to be problematic, considering the quality of patient care. Previous studies have brought up that, as career development is connected to professional competency improvement, it is likely to extend professional values, such as promoting care quality and patient safety (Haines et al., 2021;Yarbrough et al., 2017). In this study, an even salary for all the nurses regardless of their work performance was brought up. Those who aimed for high quality in their work were not rewarded. This is prone to causing resentment but also to hinder motivation to perform the best.
Poorly conceived career development options might be one of the reasons why nursing mainly remains an undervalued women's profession with low pay and poor working conditions (Bayliss-Pratt et al., 2020). These adverse working conditions, along with underdeveloped career advancement options, lack of in-service training (Simpson & Simpson, 2019) and also nursing's inherent challenges (Kox et al., 2020) may change nursing into a job without security (Bodin et al., 2020). Precarious working conditions, unfortunately, already hamper the quality of working life in nursing, manifested, in addition to the above-mentioned issues, as low autonomy, poor control over working times, overwork and high demands (Bayliss-Pratt et al., 2020;Hult et al., 2022). Like the participants in this study, many nurses currently intend to leave nursing, though the lack of career development options is only one reason among others.

| Limitations
We interviewed nurses during the COVID-19 pandemic. Considering motivational and career development issues in this kind of burdensome situation may be secondary for them and thus produce biased findings compared with a more conventional situation. Also, the COVID-19 pandemic has been shown to increase nurses' dissatisfaction with work and intentions to leave (Lavoie-Tremblay et al., 2022).
On the other hand, data collection with remote access in the time of the pandemic enabled nurses to participate at times convenient for them. We did not carry out repeat interviews or return transcripts and request feedback.

| IMPLICATIONS FOR NURSING MANAGEMENT
Nurse leaders have a significant role in supporting nurses' motivation and engagement in their careers. This study showed that nurses value increased competency and development possibilities, which lead them to wish for reasonably challenging work tasks. Nurse managers' support and encouragement and, concretely, allocation of working time for training are some of the factors that may increase the meaningfulness and motivation for nurses to engage in their career. Nurses need clear, equal and motivating career paths and models; however, nurses who want to do a very basic job should also be supported. This study showed that career advancement should also be reflected in pay. Nevertheless, the study found that advocacy and involvement in decision-making are as important as pay. Nurse managers and leaders should foster involvement and interest in career development by applying a respectful and inspiring leadership style.

CONFLICTS OF INTEREST
The authors have no conflicts of interest to declare.

ETHICS STATEMENT
Ethical principles were followed throughout the research process (ALLEA, 2017). In Finland, ethics committee approval is not required for this type of study, which interviews adults who volunteer and are competent (Ministry of Social Affairs and Health, 1999). However, permissions for data collection were obtained from the research councils of each trade union and workforce leasing company before the data collection phase. We obtained informed consents from the participants, electronically and verbally, and provided them research information, including voluntariness and the right to withdraw (Finnish Advisory Board on Research Integrity, 2012).

DATA AVAILABILITY STATEMENT
Research data are not shared.