HEALTH SYSTEM RESEARCH

WHY REGISTERED NURSES (RNs) DO NOT PURSUE THEIR DEGREE IN NURSING ?

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GROUP 1
DAYANA DEVI EUGENIA STEPHANIE KALAH PANG SEX CHING PNG KHAR BOON REVATHY TAN MAY NIE ZAHARAH TONG WEN TENG
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CHAPTER 1: INTRODUCTION

1.0 Introduction
Nursing is a profession which has evolved from an occupation with no theory involved to a profession which requires one to have a higher level of education.
Hospital-based nurses believe that they need to obtain an undergraduate degree to maintain the standards of practice and professional development as patient care has become more demanding in the clinical scene (Chapman & Hall,1992).
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1.0 Introduction
For the profession to develop in Malaysia, RNs should possess at least a Degree in Nursing.

1.1 Problem Statement

Bernama (2008) states only a mere 3% out of 75,000 nurses in the country possess a degree in nursing. Arshad (2008), earning a degree in nursing would result in a nurse being capable of making cogent arguments to arrive at critical conclusions and consequently execute actions that would greatly enhance and improve the level of skill and services within the industry.
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1.1 Problem Statement

Therefore, we strongly feel that it is important to find out why RNs are not pursuing a Degree in Nursing for the betterment of the nursing profession.

1.2 Objectives
1. To identify the problems encountered by RNs in pursuing a Degree in Nursing. 2. To explore the problems encountered by RNs in pursuing a Degree in Nursing.

1.3 Operational Definition

Registered Nurse (RN) A person who has undergone a formal course of nursing education and is registered with the Malaysian Nursing Board. www.medicalprac.moh.gov.my

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1.3 Operational Definition

Degree in Nursing An undergraduate course in nursing which aims to prepare nurses to be capable of carrying out professional responsibilities in clinical nursing and improve quality service through research and advanced development in nursing.
www.ukmmc.ukm.my

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CHAPTER 2: LITERATURE REVIEW

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2.0 Lack of time

Many nurses work extra shifts and overtime while leading busy personal lives such as making time for their hobbies, new skills and social activities .They may be challenged to find time to return to pursue higher education. (Morgenthaler, 2009)

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2.1 Family commitments

Family commitments restrict the flexibility of the nurses availability. (Gould et al, 2007)

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2.2 Working environment

Working condition further impedes nurses availability to engage in higher education. Due to shortage of staffs, they need to work extra hours. (Bibb et al, 2003)

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2.3 Financial constraints

Educational expenses continue to rise during the economic crisis, and nurses often do not want to add another burden to their financial situation. (Morgenthaler, 2009)

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2.4 Lack of information regarding pursuing a Degree in Nursing

Many adults have little knowledge of opportunities for learning or where to go to get such information. (Bridge et al, 1993)

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2.5 Lack of confidence

Being expected to conduct research and to write papers at a professional level also may add to nurses hesitation to return to school. (Morgenthaler, 2009)

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2.6 Poor English proficiency

Those with a poor command in English face uncertainties on whether or not they would be able to cope with the lessons which are in English. (OMahony & Sillitoe, 2001)

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CHAPTER 3: RESEARCH DESIGN & METHODOLOGY

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3.0 Selection of study area

The research was done in a private Hospital, Hospital X in Petaling Jaya.

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3.1 Study sample

50 RNs with more than 1 year of working experience and have not pursued a Degree in Nursing from different wards in Hospital X were randomly chosen.

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3.2 Data collection instruments

The questionnaire was developed after a comprehensive review of the literatures. The questionnaire consists of 22 questions.

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3.3 Data collection

Data collection was carried out by distributing the questionnaire to the RNs of Hospital X.

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3.4 Ethical consideration

In this research, permission was granted by the Director of Nursing of Hospital X and Principal Tutor of College X.
All the identities of the participants for the study will be kept confidential.

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3.5 Pilot study

5 RNs were randomly chosen for this pilot study using our questionnaire.
After collecting the results, instructions were improved for better understanding.

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3.6 Data processing and analysis

Calculation of all the answers from the subjects and the statistical analysis were done manually. After organizing all the data, they are arranged in the form of charts.
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CHAPTER 4: DATA ANALYSIS

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%
80% 70% 60% 50% 40% 30% 20% 10% 0%
20-25

Age of RNs in Hospital X

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6
26-30 31-35

2
36-40

Age

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ST 1

OBJECTIVE

To identify the problems encountered by RNs in pursuing a degree in nursing.

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ND 2

OBJECTIVE

To explore problems encountered by RNs to pursue a degree in nursing.

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%
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CHAPTER 5: SUMMARY & CONCLUSION

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5.1 Discussion
From our research, we have found out that RNs are aware of the importance of having a Degree in Nursing and this statement is supported by 82% of them.

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5.1 Discussion
The problems that the RNs encountered are divided into 7 factors : i. ii. iii. iv. Financial constraints Lack of time Poor English proficiency. Lack of information regarding degree in nursing program v. Family commitments vi. Working environment vii. Lack of confidence
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i.

FINANCIAL CONSTRAINTS

Financial constraint is the main problem faced by RNs to pursue a degree in nursing which is supported by 20% of them.

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i. FINANCIAL CONSTRAINTS
When explored majority of them claims, this problem is because they have to pay off existing loans, followed on by high living expenditure, the need to support family members, to pay for hefty insurance premiums and to cover high social expenses.

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i.

FINANCIAL CONSTRAINTS

Nurses who responded to a research by Morgenthaler (2009), said that they need to focus on paying off previous mortgage and will try not to go into further debt for education.

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ii. LACK OF TIME

The second barrier is lack of time. Most RNs who find lack of time a problem said they face difficulty in obtaining study leaves followed on by prolong working hours, engaged with family, social and religious activities.

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ii. POOR ENGLISH PROFICIENCY

Poor English proficiency is also another problem encountered. All the respondents agreed English is important, but they feel that their English proficiency does not meet the standards to pursue a nursing degree program.
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ii. POOR ENGLISH PROFICIENCY

Barritt (2002), The delivery of taught sessions is often dependent on the student having an understanding of the appropriate vocabulary. This can often form a barrier for those whose English is a second language or for those who have had a break from education
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iii. LACK OF INFORMATION

Most of the RNs lack basic information regarding the degree program offered such as entry requirements, course fees, loans offered, duration of the courses, are the institutions recognized, types of programs offered and about the intakes per year

Many potential students felt that they had not received enough information about university courses especially the types of programs offered that would best suit their capabilities. (Barritt,2002)
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 Majority of them says they have to take care of their family members. However, they also claimed that their families would be supportive if they want to pursue a nursing degree.
Hence, it is the RNs herself who views that she has a high level of obligation as a family member and cannot find time to commit towards her studies.
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iii. FAMILY COMMITMENT

iii. FAMILY COMMITMENT

Family obligations come first in my life, I cannot leave my family as said by a respondent in a research cited from Adami and Kiger (2005).

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iv. WORKING ENVIRONMENT

The factors that contributes are:
Lack of staff High workload High patient care demand Prolong working hours Mandatory overtime No encouragement from ward sister No cooperation among colleagues
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iv. WORKING ENVIRONMENT

Our finding is congruent with a research done by Adami and Kiger (2005) whereby nurses said they would most likely be unable to leave their work site because of an inadequate supply of qualified nurses in the practice areas.

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v. LACK OF CONFIDENCE
Lack of confidence is the least of the RNs
problems.
When explored, the contributing reasons are: Lack of working experience Afraid unable to adapt to the studying environment Afraid unable to follow the syllabus of the program Poor oral and written English Afraid of failure Previous tough studying experience Lack of co-workers support.
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v. LACK OF CONFIDENCE
Morgenthaler (2009) says being expected to conduct research and to write papers at a professional level also may add to nurses hesitation to study. An apprehension of not being smart enough or possibly failing may be a concern.

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5.2 RECOMMENDATIONS
1. Benefits of obtaining a degree in nursing 2. Provide information regarding financial assistance.

3. Tips on handling time management.

4. Ways to improve English proficiency. 5. Provide ways to get information regarding a degree in nursing program.
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5.3 Implication
From our research, we have identified the problems RNs encounter to pursue a degree in nursing.

A nursing degree is required to maintain and improve your professional knowledge and competence. Foundation education alone, however cannot effectively meet the changing and complex demands of the range of modern health care. (Furze.G,1999)

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5.3 Implication
Therefore we ultimately hope to create a better awareness among RNs to pursue a Degree in Nursing which can help in the development of capable and effective professional nurses.

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5.4 Limitations
Lack of experience Poor English proficiency

Inadequate time
Lack of recent resources Poor internet connection
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5.5 Conclusion
Pursuing a degree in nursing is very important for nurses in order to keep in pace with medical advances, to develop knowledge and skills for personal growth and competence. It is proven that majority of the respondents think that having a degree in nursing benefits them. However, the RNs face some problems that hinder them from pursuing a Degree in Nursing.

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5.5 Conclusion
We hope the recommendations mentioned will be beneficial towards the RNs quest to obtain a nursing degree.

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71

Introduction
Healthcare technology is constantly advancing and developing. The health needs of the population are also become more demanding and ever changing. Hence, nurses must continue to further their education and update themselves in order to keep abreast with medical advancement.
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Introduction
Exposure to a nursing degree will improve nurses foundation in nursing knowledge, and essential management skills such as: critical-thinking, problem solving, decision-making skills, communication skills, leadership skills.

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Introduction
The level of nursing education and staff preparedness can have a profound effect on the quality of patient care and positive patient outcome. (Morgenthaler, 2009) In order for the nursing profession to achieve professionalism, it require greater skills, higher education and life long learning. (Mersery & Manso, 1997 as cited in Muthu & Chong, 2008)
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1.Benefits of a Degree in Nursing

5.Provide ways to get information regarding a degree in nursing program 2.Provide information regarding financial assistance

Recommendations

4.Ways to improve English proficiency

3.Tips on handling time management.

(a) To become a more competent and efficient nurse

Degree in Nursing will lead nurses to be in a better position as they would be able to manage the challenges in the clinical settings which require them to think critically and act fast to solve problems. Hence, this will prepare nurses to provide better quality nursing care.

(a) To become a more competent and efficient nurse

Although RNs felt they returned to school as skilled, knowledgeable and professional practitioners, they reported growing beyond their expectations in areas of knowledge and professionalism, which they felt led them to become more effective change agents and patient advocates. This benefited their patients in providing better quality nursing care. (Delaney&Piscopo, 2007)

(b) Improvement in remuneration

As the standard of living is soaring every year, nurses should prepare themselves for a higher remuneration, otherwise they will be unable to lead a basic life comfortably. With a higher academic qualification, nurses can demand for a better pay.

(c) To gain a promotion

Academic advancement is an essential criteria to be promoted. Therefore, RNs with a diploma must pursue a degree in nursing if they want to compete with their colleagues for a promotion.

(c) To gain a promotion

Nurses with postgraduate preparation will have better opportunities for advancement and will be able to undertake advanced clinical roles. (Mental Health Nursing Education and Health Labor Force, 2007)

2. Financial aids
20 % of RNs claimed that financial constraints hinder them from pursuing a degree in nursing. Therefore, we have gathered information to help motivate them to overcome this problem.

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Course fees of Degree in Nursing program

Local University University Malaya
Open University Malaysia International Medical University

Fees/course RM11,562.30 - RM11,828.10

RM22,390

RM36,000

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Course fees of Degree in Nursing program

Nursing Degree Affiliated with Oversea University Monash University (Australia) Fees/Course RM52,520.00

MAHSA (Northumbria UK)

RM27,000

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Information regarding financial assistance

(A)

(B)

(C)

Loans

EPF

Scholarship

(i) Perbadanan Tabung Pendidikan Tinggi Nasional (PTPTN)

(ii)

Personal Loan from Bank

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(i) PTPTN
Interest rate : fixed 3% monthly Tenure : based on total loan amount (from 60-240 months)

Repayments will commence only 6 months after graduation

Easy methods of repayments -deduction of salary -cheque/bank draft/money order -online payment
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Personal loan from bank

CIMB Bank Amount of Loan Minimum : RM10,000.00 Maximum : RM100,000.00 Tenure : 10 years Interest : 3.75% p.a fixed for first 2 years Monthly installment via online banking or CIMB Bank Branch ATM & Cash Deposit Machine (CDM)

Employee Provident Fund (EPF)

Benefits
Full or partial withdrawal of money from Account 2 (Education) Withdrawal can be done either every semester or every academic year

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Scholarship Offered by Private Hospitals

There are Private Hospitals offering scholarship for RNs who work in their hospital. The benefits of this scholarship are:- applicant will be sponsored on course fees, exam fees and resource materials - study leaves can be arranged easily - will be bonded by contracts upon completion of course
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3. Tips on handling time management

To achieve maximum success and productivity in the work place, it is essential that we understand how we use our time at work. Like many things in life, we take time for granted and give little thought to it until we no longer have enough of it. We all have the same amount of time each day but it is how effectively we use it that is important. (Geimure. K, 2003)

3. Tips on handling time management

Feeling busy and creating excuses are the common reasons for those who are not able to achieve their essential goals in life. However, if one has the motivation to drive them to focus on her aims and goals, she will be successful in achieving betterment in life. Therefore, RNs should plan effective ways to manage their time and to accomplish their goals.

3. Tips on handling time management

(a)Techniques on managing your time effectively

(b) Interpersonal skills

(c)E-learning
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 To attend CPD ( 4/10/09) Driving license practice

Language class es (Every Tuesday)

Going back hometown To attend relative wedding ( 6/10/09) class class

Pay bill

Grocery shopping

class

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(a) Techniques of effective time management

I. Prioritize your objective

II. List and III. Develop prioritize the self activities to discipline accomplish to your accomplish objectives your goals

IV. Set time limits for every task

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 Not all objectives you have are equally important. Give higher priorities to the objective that are most important.

(Steiner. S, 1999)

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 The only person who knows you completely is yourself. And nobody can track your goals for you.
(Agarwal. A, 2009)

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(b) Interpersonal skills

Interpersonal skills is an essential ability for a person to operate within organizations through social communication and interactions. Therefore, good interpersonal skills are vital for RNs to build rapport among themselves.

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(b) Interpersonal skills

For example, nurses who did not get the shift she requested, can use her interpersonal skills to ask her colleagues for an exchange of shift.
Besides that, nurses also can used this skill to inform ward sister about her studying schedule. Hence, ward sister can plan the roster accordingly as the best solution for obtaining study leaves.
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(c) E-Learning
E-Learning method is an online base course. Nurses should also choose degree in nursing programs which best suits their timing capabilities. We recommend institutions with part time courses where some modules are done through E-Learning.

(c) E-Learning
Advantages:

Physical attendance is not required. Learning is self paced. One does not need to be bind by time and place. Reading materials are available and can be downloaded for reading at a later time.

(c) E-Learning
The e-Learning method is a flexible, web-based system that allows nurses to complete required courses and seminars in a way that suits their individual schedules. (College of Nursing, Taipei Medical University)

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Part time Degree In Nursing Program (OUM)

Education should be made available to all, regardless of time, place, age and social economic background. The open and distance learning (ODL) mode is specifically targeted at working adults who need to take care of their families as well as manage their careers while pursuing higher education.
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4. Improve English Proficiency

16 % of RNs mentioned that their poor English proficiency deterred them from pursuing a degree in nursing. English is an universal language which is used by majority of the worlds population. Being proficient in English will bring tremendous advantages. as most of the informative materials are in English
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4.Improve English Proficiency

Therefore, it is strongly recommended that all nurses must put in great effort to achieve proficiency in English for continuous self improvement.

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4. Improve English Proficiency

Malaysian nurses are of good repute internationally and are held high esteem and recognized to be on par with nurses from the developed countries. The only drawback among our nurses is their comparative lack of proficiency in the English language (Dato Sri Chua J.M ,2003)

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Ways to improve English proficiency

4 main components of the English languages In-service Nursing Education Program

Online English Learning

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Improve 4 main components of English

Learning a language is a gradual process, and it cant be done within a night. For one to master English language, one will have to master these 4 basic components of language which are reading, listening, writing and speaking.
http://www.ezinearticles.com

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Improve 4 main components of English

Components Recommendations

Reading Listening Speaking Writing

Read suitable materials such as books, magazines, newspapers, websites or journals which one is interested in Listen to English radio channels, watch English movies, documentaries and news in English Communicate with friends or colleagues in English
Writing a diary or blog or short stories in English
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To master these 4 components one must remember

Learning English is a gradual process

Be patient with yourself

By applying this, one can achieve their Practice Make learning goals makes perfect a habit
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Improve 4 main components of English

Doing it every day would be pretty hard especially
if you come from cultural background where people do not really speak English that much. The first step to turn this into reality is try to find and discuss with a few friends who want to improve their English. (Sundram. R, 2009)

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Online English Learning

Modern technologies such as the internet can be used to improve ones English proficiency according to their pace and privacy.
Through this, one can improve basic English skills. However, one must have selfdiscipline to learn it continuously and successfully.
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Online English Learning

In accordance to this, we recommend RNs to make use of free online English based programs as it is inexpensive and can be done at anytime.
Online English learning can help you to become a great speaker of the English language (Lioyd. G, 2008)
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In-Service Nursing Education Program

This program is to update RNs with nursing issues and improve their English proficiency. RNs would have to prepare the presentation This will indirectly improve RNs reading, writing, listening & speaking skills. Thus, build up their confidence.
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Internet

Newspaper

Education Fair

Provide ways to get information regarding a degree in nursing program

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Modern technology carries a vast array of information resources and services. By just clicking, all the information sought for will be on the screen within seconds.

Study Malaysia. com is a comprehensive and informative educational website that complements well to the efforts of the Malaysian government to promote studying opportunities in Malaysia.

It provides basic information regarding degree program offered in Malaysia and also the contact details if the RNs would like to know more.

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Example of the basic information

Mahsa University College
Entry Duration Requirements
Diploma in 2 years (4 Sem) Nursing Min. 3 years working experience Currently practising as a registered nurse

Fees

Type of program

Intake/year
May July September

RM 27000/ Face to face course tutorial/on campus learning E-learning

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List of higher education institutions in Malaysia which are recognized by the Malaysian Nursing Board and MQA
Local public institutes of higher learning
University Malaya Universiti Putra Malaysia (UPM) Universiti Sains Malaysia (USM)

Local private institutes of higher learning

International Medical University (IMU) Open University Malaysia (OUM) Mahsa University College

Universiti Kebangsaan Malaysia (UKM) Masterskill University College Universiti Malaysia Sarawak (UNIMAS) Unity College International Islamic University Malaysia (UITM) Nilai University College UCSI University

Newspapers
Daily newspapers like New Straits Times, The Star, The Sun, Utusan Malaysia are always advertising degree programs offered by colleges and universities.
RNs should pay attention to the advertisement on the newspapers from the college or university they are interested in.

The Star (09/07/09)

 Education Fairs provide RNs with an opportunity to get first-hand information on the courses.

Education Fairs are recognized by the education industry as one of the most effective platform to promote and disseminate information on courses offered by renowned institutions of higher learning. www.webafairs.com

The Star Education Fair

Held annually. It features the most comprehensive range of study opportunities available in Malaysia. Involves 187 higher learning institutions Information are given verbally, and also in the forms of brochures, pamphlets and even booklets.

Conclusion
There are benefits in pursuing a degree in nursing. However, RNs face problems that hinder them. The only way to overcome these problems is for the RN to motivate herself to improve on her weaknesses and find solutions which can aid her.

Conclusion
We hope our recommendations can help motivate them to study. The future of the nursing profession lies in the hand of the nurses themselves. As the saying goes When there is a will , there is a way

References
Adami, M.,Kiger, A,.(2005).A study of continuing nurse education in Malta : the importance of a national context. Nurse Education Today, 25, 78-84. Aiken,L.,Clarke,P.,Cheung,B.,Sloane,M.,Siber,H.(2003).Education levels of hospital nurses and surgical patient mortality.JAMA, 290(12) ,1617-1623.

Barritt, E. (2002).Confronting the Barriers: Rural Students and Access to Higher Education
Beatty, R.(2001).Continuing Professional Education,Organizational Support, and Professional Competence: Dilemmas of Rural Nurses.The Journal of Continuing Education in Nursing 32(5),203-209.

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References
Bibb, S.C., Malebranche,M., Crowell,D.,Altman, C.,Miller, S.,Miller, T.,Rybarczyk, J., 2003. Professional development needs practicing at a military community hospital. The Journal of Continuing Education in Nursing, 34(2), 39-47 Bridge, H., Salt, H., Dale, M., Davies, J. and Morgan, J. (1993), access and Delivery in Continuing Education: A Guide to Contemporary Literature, University of Nottingham, Nottingham. Chapman,R., Hall , B. (1992).Post registration education in three fields of clinical practice.Nursing Times 88(43),53-56. Darkenwald,G.,Hayes,E.(1988).Assessment of adult attitudes towards continuing education.International Journal of Lifelong Education,7(3),197-204.

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References
Delaney,C.,Piscopo,B.(2004). RNBSN Programs:Associate Degree and Diploma Nurses Perceptions of the Benefits and Barriers to Returning to School. Journal For Nurses In Staff Development,20(4), 157-161. Furze G,Pearcey P(1999) Continuing education in nursing: a review of the literature.Journal of Advance Nursing 29(2),355-363.

Griffitts, L. (2002). Geared to achieve with lifelong learning. Nursing management. 33, (11), 22-25.
Gould, D., Drey, N., Berridge, E.-J., (2007). Nurses experience of continuing professional development. Nurse Education Today, 27 , 602-609. Lee, C., Levet-Jones, L. (2005). Continuing Education for Nurses: A necessity of a nicety? The Journal of Continuing Education in Nursing, 36(5).

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References
Long, K. Bernier, S. & Aiken, L. (2004). RN Education: A matter of degrees : Nursing: 34 (3), 48.

Ministry of Health [MOH]. (1998). Report of the Ministerial Taskforce on Nursing: Releasing the Potential of Nursing. Wellington
Morgenthaler,M (2009) . Too old for school? Barriers nurses can over come when returning to school. AORN journal 89(2), 335-345. OMahony, B.,Sillitoe, J. (2001) Identifiying the perceived barriers to participation in tertiary education among hospitality employees,International Journal of Contemporary Hospitality Management 13(1),21-29. Perry, L. (1995). Continuing Professional Education: Luxury of Necessity? Journal of Advanced Nursing. 21, (4), 766-771 Reed, J. & Procter, S. (1993). Nurse Education: A Reflective Approach. London: Hodder & Stoughton

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References
Sanders CM,Yankou D, Andrusyszn MA.(2005) Attention and restoration in post-RN students. Journal Continuing Education for Nurses.36(5),218-225. Schwirian, P.(1998).Professionalization of Nursing (3 rd ed).Philadelphia:Lippincott Smith, S.(2003). Alaska Re-licensure Survey for Registered Nurses, Alaska Colleagues in Caring

Ibrahim, Z. 2008, Get Your Degree, Nurses Urged < http://bernama.com/bernama/v5/newsindex.php?id=322298 >(26 Aug 2009)
<http://medicalprac.moh.gov.my/uploads/nursing_board_malaysiacode_of_professional_conduct_1998.pdf >(31 AUG 2009) <http://www.ukmmc.ukm.my/ index.php?menuid=MN09040348> (31 AUG 2009)

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Brecht . G (1996).Stress management Sorting out stress. Prentice hall.
Robbins. Coulter (1999) Time management. Management (6th ed). Prentice Hall. <http://thestar.com.my/edufair/> (3 SEP 2009) <http://thestar.com.my/news/story.asp> (3 SEP 2009) <www.studymalaysia.com> (4 SEP 2009)

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Thank you for your attention !!!

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Do you have any questions ?

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