Exploring the motivation and barriers that nurses experience when enrolling for a Master’s in emergency and disaster nursing

Background: There is a growing interest in postgraduate nursing education in Saudi Arabia, including the availability of Master’s and PhD degrees in nursing. Consequently, various specialized studies in nursing have emerged, such as the Master’s in emergency and disaster nursing. However, only a limited number of studies have been conducted in Saudi Arabia to explore the factors that can have a positive or negative impact on a Master’s program from the students’ perspective. Furthermore, no studies have investigated the motivation and barriers encountered by registered nurses when it comes to enrolling in a Master’s program in emergency and disaster nursing at Taif University. Methods: A qualitative descriptive approach was employed for this study. A total of 12 postgraduate nurses who had successfully obtained a Master’s degree in emergency and disaster nursing from Taif University participated in the research. Results: Two themes emerged from the analysis. The first theme centered around the motivation to enroll in the Master’s degree program, which encompassed the desire to improve knowledge and skills, enhance self-learning abilities, and achieve financial advancement. The second theme focused on the barriers faced when enrolling in the Master’s program, which included challenging admission criteria and requirements, high program costs, and difficulties in obtaining scholarships. Conclusions: This study identified several motivations and barriers related to the enrollment in a Master’s program in emergency and disaster nursing at Taif University. Therefore, it is recommended that efforts be made to increase financial support and facilitate fellowships to support students in their pursuit of this program.


Background
To ensure the provision of safe and effective healthcare for patients, nurses must possess both knowledge and competence [1]. However, in order to acquire the necessary knowledge and skills, nurses need to be motivated to actively engage in continuous learning [2]. Lifelong learning is a multidimensional concept that encompasses ongoing professional development throughout one's career, including peer learning and participation in postgraduate programs [3]. As a result, there has been a growing trend in postgraduate specialization programs, which serve as avenues for education and motivation [4]. Cathro highlighted various barriers to pursuing graduate studies in nursing, including financial costs and the need to maintain employment [5].
In the past, Saudi Arabia had ample access to high-quality foreign nurses, which resulted in limited pressure or incentives for nursing schools in the country to expand their enrollment. Additionally, nursing programs experienced low enrollment rates [6], this was influenced by factors such as mixed working environments, cultural issues, the influence of family dynamics, and diverse working conditions, including night shifts specifically for female nurses [7]. However, with the introduction of the Saudisation system, Saudi universities have faced increasing pressure to enhance their capacity and establish new nursing programs [8]. Consequently, nursing colleges and the Ministry of Health have collaborated to initiate enrollment programs in nursing colleges and ensure employment opportunities after graduation. This marketing strategy has successfully attracted high school students, thereby addressing the crucial issue of nursing shortages through nursing practice, research, and education [9].
In Saudi Arabia, family life holds significant importance, and balancing work commitments with family responsibilities can be challenging for nurses. Therefore, a key factor for successfully modernizing the Saudi workforce is ensuring an improved supply of nurses, starting from middle and high school to nursing school, followed by diverse career paths that include postgraduate education. There are opportunities to modernize existing postgraduate nursing education, introduce new postgraduate programs in nursing, and establish new positions and career paths for nurses, such as telenursing, informatics, and quality management [10]. Furthermore, Saudi nurses have a strong desire to pursue postgraduate studies [11].
Emergency departments constitute the entry point for almost half of hospital admissions. Consequently, the demand for emergency care is increasing at a rate higher than population growth. Additionally, addressing the shortage of nurses and filling vacancies in critical care areas present considerable challenges [12]. Therefore, several strategies, including continuing and postgraduate educational programs, have been explored to enhance motivation and attract more nurses to the field of emergency and disaster nursing. Specializing in emergency care not only holds potential economic benefits but also may has a positive impact on patient care and outcomes [13].
Studies have brought attention to a concerning issue regarding the lack of motivation among nurses to study and work during emergency and disaster situations [14]. Postgraduate emergency and disaster nursing students often face various barriers and experience high levels of distress [15,16], which can significantly impact their motivation to specialize in this field [17].
There is a scarcity of literature on the topic of motivation and barriers to postgraduate studies in nursing. Therefore, gaining a comprehensive understanding of nurses' motivation to pursue postgraduate education can contribute to the development of an effective learning environment, and educational strategies can be tailored to address individualized learning needs [18]. Thus, the objective of this study is to explore the motivating factors that encourage nurses to participate in the postgraduate emergency and disaster nursing program at Taif University, as well as identify the barriers they encounter during the enrollment process.

Methods
A qualitative descriptive approach was employed in this study. All graduate and postgraduate students from the Master's degree of emergency and disaster nursing program at Taif University were invited to participate. A total of 12 participants willingly enrolled in the study. Semi-structured interviews were conducted to explore the motivations and barriers experienced by nurses in relation to their enrollment in the Master's program for emergency and disaster nursing at Taif University. The interviews were scheduled at a convenient time and location for each participant. The duration of each interview ranged from 40 to 50 minutes. Prior to the commencement of each interview, participants were asked for their consent to audio-record the conversations. Open-ended questions were utilized during the interviews, with two main inquiries: "what are your motivations for joining the Master's program?" and "in your view, what obstacles have you faced in pursuing the Master's degree?". The interviews were conducted in Arabic and subsequently transcribed into English. Thematic analysis of the data commenced shortly after each interview. Both researchers were mindful of the study's confirmability, credibility and transferability. For instance, they sought further clarification from participants during the interviews to ensure accurate interpretation of their statements. Additionally, both researchers actively listened to all the interviews, verifying the correctness of the meanings conveyed. The data were analyzed, and both researchers reached a consensus on the identified themes of the study.
Ethical approval for this study was obtained from the Research Ethics Committee of Taif University, Saudi Arabia, on August 21, 2022, with the assigned code number HAO-02-T-105. Prior to their participation, all participants were asked to provide their agreement and signed consent forms. They were informed about their right to withdraw from the study at any time without facing any adverse consequences.

Results
The study included a total of 12 postgraduate nurses, with 3 females and 9 males. All participants held a Master's degree in emergency and disaster nursing from Taif University ( Table 1).
The participants' ages ranged from 30 to 42 years, with a mean ± SD of 35.9 ± 3.8 years. Their nursing experience since graduation ranged from 7 to 20 years, with a mean ± SD of 13.4 ± 3.9 years. The majority of participants were married (10, 83.3%), while only 2 were single (16.7%). Among the participants, 7 (58.3%) resided in Taif city, while 5 lived outside Taif city (41.7%). The main themes identified in relation to motivation for enrolling in the Master's program were the desire to enhance knowledge and skills, as well as the opportunity for self-learning and financial improvement. Conversely, the primary barriers that deterred participants from enrolling in the Master's program were the challenging enrollment criteria and requirements, the high cost of the program, and the difficulty in obtaining a fellowship.

Improve knowledge and skills
All participants mentioned that they were highly motivated to apply for the Master's degree in emergency and disaster nursing (EDN) to increase their knowledge regarding this specialty, as quoted below: "The main motive that stimulated me to apply for the Master's degree was to develop a strong scientific background so as to be specialised in the EDN field" (participant 2).
"I needed to have experience and knowledge in the field of EDN. This is what motivated me most to apply for the Master's degree" (participant 7).
"I felt motivated to apply for the Master's degree in EDN so as to improve my academic level, to obtain specialised information, and to conduct research in that field" (participant 12).
Some of them stated that the study for a Master's degree had improved their skills in many aspects, such as academic writing and research skills, as quoted below: "I sought to apply for the Master's degree in EDN mainly to gain the necessary skills in research" (participant 8).
"As you know, science is developing rapidly, especially in the health field. And I believe that read in deep in the field of nursing is important, which leads to increasing our knowledge and skills and this is one of the most important reasons for joining this program" (participant 10).

Improve self-learning
Participants noted that during the study for the Master's degree, self-learning was the main learning style, which encouraged them to learn, as quoted below: "During my study for the Master's degree, I was challenged with the new style of teaching, which enforces self-learning, especially during our distant online learning that was applied during the COVID-19 active pandemic" (participant 4).
"There is a pressing need to promote self-directed learning, which will improve our learning capabilities during our studies for the Master's degree" (participant 3).
"I found that self-learning is the most suitable learning style during my studies. Our professors helped us a lot to develop our self-directed learning" (participant 6).

Financial improvement
Although those enrolled in a Master's programme pay fees, many of the participants stated that achieving this postgraduate degree is essential, as it will help them to increase their salaries, as quoted below: "…financial incentives and administrative promotion are important motives for postgraduate studies" (participant 1).
"Studying after being employed has its benefits. For me, it is an additional financial and career improvement factor" (participant 5).
"Obtaining an accredited academic degree will facilitate professional classification, which will be reflected in financial benefits" (participant 6).
"The most important difficulties that I encountered are the high financial expenses. As you know, we're far away, and we need airline tickets. And housing and accommodation expenses in the city." (participant 9).

Theme 2 The barriers to enrolling in the Master's degree
The challenging enrolment criteria and requirements All participants indicated that some of the enrolment requirements were difficult, such as passing the International English Language Testing System (IELTS) with at least 5 in each component, in addition to the limited number of available seats for applicants, as quoted below: "The IELTS is one of the common difficulties that we have to pass in order to be eligible to apply for the Master's degree" (participant 1).
"Mastering a good command of English is an important and difficult barrier for being accepted to enrol into the Master's degree of EDN" (participant 6).
"I was lucky to have a good score in the IELTS exam, while many others could not pass it and hence could not apply for the Master's degree" (participant 7).

The high programme cost
The tuition fees for each semester in the Master's degree of EDN constitute a difficult obstacle for many applicants. In addition, participants who were living away from Taif city had to pay for their transport and residence during the programme, as quoted below: "To apply for the Master' s degree, I pay high tuition fees. Moreover, the period for payment of the tuition fees is so tight, after which your enrolment is immediately cancelled" (participant 4).
"In addition to the tuition fees, I had to fulfill extra payments for the high cost of transport from home in Abha to Taif city in addition to the apartment rental during my stay in Taif city" (participant 11).
"Travel from Jazan to Taif city and the high tuition fees constitute the most important obstacles to enrolling for the Master's degree" (participant 12).

The difficulty of obtaining a scholarship
Since all participants were employed, getting a scholarship was highly necessary since it is hard to organise time and daily efforts between work and study. However, obtaining a fellowship was not an easy task and necessitated going through the fulfillment of many approvals and procedures. Nevertheless, most of the participants were happy about benefiting from the online studies during the COVID-19 pandemic, as quoted below: "The common problem between the Ministry of Education and the Ministry of Health regarding the deployment Internal Scholarships Program (EIFAD) system. I remember, before I got the approval for my deployment, I used to go to work in the morning till 4:00 p.m., and then I had to fly to the university to catch the first lecture, which also starts at 4:00 p.m. It was so difficult, especially with the problem of transportation and difficulty of moving during the coronavirus period" (participant 3).
"One of the difficulties was the problem of the long working hours, until the afternoon, and then we go to the university whose lectures start immediately afterward and sometimes continue till almost midnight. It was not until a full-time year had passed when the coronavirus pandemic occurred that distance learning started and things became easier as we attended the online lecture from anywhere" (participant 5).
"The problem of deployment Internal Scholarships Program (EIFAD) was one of the main obstacles. Since I am working and living in Abha city, I had to travel each week to Taif city. At first, I had to take a leave for 3 months due to the difficulty of timely management of my university studies in Taif with my work in Abha" (participant 11).

Discussion
The World Health Organization has recently highlighted a global shortage of nursing professionals, estimating a deficit of approximately 5.7 million nurses worldwide. To address this shortage, there is a need for an annual increase of at least 8% in the number of nursing graduates [19]. Postgraduate nursing programs attract self-motivated, independent, assertive, and mature graduates who prefer self-directed learning [20]. However, it is essential to identify the motivations and barriers that nurses may encounter when considering enrollment in postgraduate nursing programs [21]. Therefore, the current study aims to explore the factors that motivate nurses to engage in the postgraduate program of emergency nursing at Taif University and identify the barriers that hinder their enrollment. Moreover, the participants in the study expressed a high level of motivation to apply for the Master's degree in emergency and disaster nursing in order to enhance their knowledge in this specialized field. This finding aligns with the research conducted by Kamariannaki et al., who found that postgraduate nurses are consistently motivated to improve their professional knowledge and skills [22]. Enhanced skills and knowledge among nurses have been associated with various indicators of quality of care, including a decrease in nursing errors, increased staff productivity, reduced occupational stress, decreased hospital-acquired infections, and improved patient safety. Nalle et al. also reported that 83% of nurses perceived increased skills and knowledge as a significant benefit of their postgraduate education [23]. In addition to the motivation to enhance knowledge and skills, the participants in the present study highlighted the importance of self-learning as their main learning style. They expressed that self-learning encouraged more effective learning, sparked curiosity, motivated further exploration, strengthened problem-solving abilities, and improved time-management skills. This finding is supported by McKenna and Brooks, who emphasized that nurses are motivated to enroll in postgraduate programs to develop critical thinking and self-learning skills, which are crucial for success in the nursing profession [24]. Furthermore, almost half of the participants stated that obtaining the postgraduate degree was essential for career advancement within two years of graduation, enabling them to increase their salaries and allowances. Additionally, the interest in pursuing a postgraduate qualification was driven by the potential opportunities it could bring, such as business prospects and opportunities for research and collaboration with academics and professionals in the same field or discipline. Therefore, increasing the enrollment of professional nurses in postgraduate programs is significant for their clinical and academic self-development [25].
In Ireland, Murphy et al. identified several reasons why nurses should engage in postgraduate studies [26]. These reasons include enhancing their curriculum vitae, gaining professional recognition, experiencing accelerated career progression, improving salary prospects, and increasing job satisfaction. Kamariannaki et al. also highlighted the significance of professional and personal factors as motivators for nurses to enroll in postgraduate and continuing nursing education [22]. Personal benefits and job security, including higher salaries and better prospects for personal promotion, emerged as primary motivations for pursuing postgraduate education.
With the increasing complexity of healthcare, it is important to explore the possible barriers against enrolment to postgraduate studies by professional nurses to increase the number of policymakers, academic authors, nurse educators and administrators. The findings of the present study shed light on various factors that hinder professional nurses from enrolling in the Master's degree in emergency and disaster nursing at Taif University. These barriers include challenging enrolment criteria and requirements, high costs associated with enrolment ah as achieving an acceptable score in the IELTS exam and limited and postgraduate studies, and difficulties in obtaining fellowships. Participants in the study expressed that meeting certain enrolment requirements, available seats for the program applicants, posed challenges that were difficult to overcome within the given time frame. Havenga and Sengane also noted that postgraduate students encounter various personal challenges during the enrolment process, while academic and institutional challenges revolve around time constraints, learning session structures, subject information, and assessment procedures [27]. The participants emphasized that the tuition fees for the Master's degree were significantly high, acting as a barrier for many nurses considering enrollment. Additionally, for participants residing outside of Taif city, the additional financial burdens of transportation and accommodation away from home added to the challenges. Havenga and Sengane reported that postgraduate nursing students face various financial, employment, family, and accommodation challenges, with the cost of postgraduate studies being a common barrier [27]. Smith et al. supported these findings, highlighting the high costs associated with applying for a postgraduate degree, making lack of finances a significant obstacle to enrollment [28].
In Australia, Fang et al. discovered that a lack of direct remuneration serves as a barrier to nurses enrolling in postgraduate qualifications [29]. There are no prospects of career advancement, such as increased financial benefits, after obtaining a postgraduate degree [30]. Summers similarly concluded that a lack of financial support is a common barrier to enrolling in postgraduate programs [31]. In South Africa, Mbombi et al. conducted a study in which nurses expressed the belief that continuing education at the postgraduate level was a waste of time, as they were not fully reimbursed or rewarded for obtaining a postgraduate qualification [32]. This perception of inadequate recognition and lack of rewards acted as a deterrent for nurses to enroll in postgraduate studies.
Perna highlights that financial challenges in pursuing postgraduate studies are multifaceted, encompassing not only the direct cost of education but also peripheral costs such as living expenses when studying away from home [33]. Additionally, the lack of income if the postgraduate student is not employed adds to the financial burden. These financial challenges can further exacerbate the academic difficulties faced by students, as limited financial resources may restrict their access to necessary literature [34]. Cleary et al. identified financial and family stressors as the two primary reasons for non-enrollment in postgraduate studies [35]. Postgraduate students report that the cost of traveling long distances and the lack of affordable accommodation as additional financial burdens. Although the participants in the present study were employed, obtaining a fellowship was highly desirable yet challenging to achieve. Murphy et al. observed that despite the availability of postgraduate nursing programs, a significant proportion of nurses may not be enrolled [26]. Difficulties in obtaining study leave and the struggle to balance studies with work responsibilities serve as significant deterrents. Taken together, these findings highlight the complex interplay between financial constraints, family obligations, and work commitments that can impede nurses' enrollment in postgraduate studies. Addressing these challenges requires considering strategies such as providing financial support, flexible work arrangements, study leave options, and affordable accommodation to facilitate nurses' pursuit of postgraduate education while managing their other responsibilities.
In the United Kingdom, Mundy and Pow highlighted the significance of support from general practice employers for nurses' postgraduate studies [21]. The support provided by employers allows nurses to be released from their clinical duties to engage in learning activities. However, the lack of such support acts as a barrier to enrolling in postgraduate studies. Nurses may feel hesitant to request time off from their clinical commitments and may be uncertain about receiving the necessary support. Cathro further emphasized that both employment and educational institutions can pose barriers to enrolling in a Master's degree in nursing, particularly when there is a lack of collaboration between these institutions [5]. This lack of collaboration contributes to the shortage of nurses in health science faculties. Coventry et al. identified several commonly reported barriers to enrollment in postgraduate degrees among professional nurses, including financial constraints, geographical location, family commitments, and refusal of support from the employer [36]. These findings underscore the importance of supportive employer policies, collaboration between institutions, and addressing financial and logistical challenges to facilitate nurses' enrollment in postgraduate studies. Strategies such as establishing partnerships between employers and educational institutions, providing financial assistance, and offering flexible study arrangements can help mitigate these barriers and promote greater participation in postgraduate nursing programs.

Study's limitations and strengths
The fact that the study was conducted at a single site can be considered a limitation in terms of generalizability to other contexts. Submit a manuscript: https://www.tmrjournals.com/in However, it also presents an opportunity for in-depth exploration and understanding of the specific context of the Master's degree in emergency and disaster nursing at Taif University. The study's significance lies in its contribution as the first national study to investigate the motivations and barriers related to the enrolment in a Master's degree in emergency and disaster nursing. By focusing on this specific program, the study provides valuable insights that can inform the evaluation and improvement of the program itself.
While the study's findings may not be directly applicable to other contexts, they can still serve as a valuable reference for researchers and policymakers in the field of nursing education. Future studies conducted in different settings can build upon the findings of this study to further explore the motivations and barriers to enrolment in postgraduate nursing programs, allowing for a more comprehensive understanding of the factors influencing nurses' decisions in pursuing advanced degrees.

Conclusions
The identification of motivations and barriers to enrolment for a Master's degree in emergency and disaster nursing at Taif University is a strength of this study. The participants' insights provide valuable information about the factors that influence nurses' decisions to pursue postgraduate education in this specific field. The motivations were mainly to promote their scientific level and learning skills, in addition to financial improvement. On the other hand, the barriers included the challenging enrolment criteria and requirements, high costs and the difficulty of obtaining a fellowship. By highlighting the need for increased financial support and facilitation of fellowships, the study provides actionable recommendations that can be implemented by the university and relevant stakeholders to remove financial barriers and promote access to postgraduate education in emergency and disaster nursing. Overall, the study's findings and recommendations contribute to the understanding of the motivations and barriers to postgraduate enrolment in this field and offer practical suggestions for improvement.