Nurses’ Views on Their Profession in Turkey and Influencing Factors

Objective: The study was conducted as a descriptive and cross-sectional to determine nurses’ views on their profession in Turkey, their commitment to the profession and participation in professional activities and influencing factors.

Methods: The study sample comprised 2253 nurses working in hospital in Turkey. The data were collected using a questionnaire developed by the researchers. For the assessment of the data, percentages, the chi square and multiple logistic regression analysis were used.

Results: According to the findings of the study based on the nurses’ statements, of the nurses, 62.3% chose the nursing profession willingly, 51% were satisfied with their profession, 75% thought that their profession was suitable for them, 59.3% might change their profession if they were offered better working or financial conditions, 15.4% considered leaving their profession, 37.2% participated in professional conferences and training courses, 72.3% did not keep up with professional publications and 32.3% were the members of the National Nursing Organization. The nurses who chose the profession willingly and had higher levels of education displayed more positive attitudes to their profession than did the nurses who did not choose the profession willingly and had lower levels of education, and the difference between them was statistically significant. The nurses having bachelor’s or master’s degrees participated in professional activities more than did the others, and the difference was significantly high.

Conclusions and Implications: As a result, it was determined that Turkish nurses had high levels of positive views regarding their profession and commitment to the nursing profession, but low levels of intentions to achieve their professional responsibilities. For nursing to gain ground in the process of professionalization, it is extremely important that its members should adopt its professional ideology, should have a positive perception of the profession and themselves, develop a positive professional identity. Therefore, nurses’ thoughts about the profession, and how well they adopt the profession should be determined and should be strengthened. This is the basis for the development of nursing as a profession.

Introduction

Rapid changes in the health care sector place new demands on nursing and nurses. Changes such as developments in advanced medical technology, changes in the general-population structure, increased workplace diversity, market orientation, short-term hospitalizations and increases in patient expectations have made nursing services complex, and thus have increased demands for professional and competent nurses to provide high-quality nursing care [1]. However, due to these changes, nurses face many professional and managerial challenges and problems in the work environment while providing nursing services, which adversely affects nurses’ perceptions of and attitudes towards the profession [2-4]. Nurses’ perceptions of and attitudes towards the profession, and how they feel and what they think about themselves and the profession affect their work motivation, self-image, quality of care, patient satisfaction, job satisfaction, job retention rates and their ability to affect changes in health care [3-5]. In several studies conducted with nurses all over the world in recent years, 9 to 26% of the nurses have been determined to consider leaving the nursing profession due to their unfavorable work environment, job dissatisfaction and burnout [6-9]. In addition, in several international studies examining nurses’ perceptions of their profession, it has been determined that nurses perceive nursing as a profession with low autonomy, perceived negatively by society, chosen due to employment opportunities, and not worth doing an academic career [4,10,11]. Nurses’ negative perceptions of their profession adversely affect the safety and quality of patient care services [12,13] and professionalization process of the profession [2]. Members of the profession who have positive perception of the profession and internalize it offer a safe and quality patient care, and make an effort for the professionalization of the profession more. According to Hwang et al., (2009) for nursing to gain ground in the process of professionalization, it is extremely important that its members should adopt its professional ideology, should have a positive perception of the profession and themselves, develop a positive professional identity. Therefore, nurses’ thoughts about the profession, and how well they adopt the profession should be determined and should be strengthened. This is the basis for the development of nursing as a profession [3].

As in the entire in world, although nursing profession in Turkey does not involve all the features of professional occupations, it is accepted as a scientific discipline, and it has made significant strides in the way to professionalization [14]. In Turkey, there are a few previously conducted studies providing limited information about nurses’ opinions regarding their profession [15,16] and professional qualifications [17,18]. However, no studies have been conducted on the same issue in recent years. This study was conducted keeping in mind that the determination of nurses’ opinions about the profession, and their internalization the profession and participation in professional activities would provide the opportunity to assess its position in the process of professionalization of nursing in Turkey and contribute to nursing in general. The results of this present study are importance, because the results will contribute to the development of new strategies in nursing and provision of quality nursing care in order for nurses to develop positive thinking about the profession and positive professional identity, positive recognition of nursing by people and other groups, and strengthening of nurses and nursing [10].

This study was conducted to determine nurses’ views about the profession, commitment to nursing and participation in professional activities and influencing factors, and the position of nursing in the professionalization process.

Background

Professionalization process is defined as “a number of changes fulfilled in the structure of the occupation to achieve professional status”. Povalko (1971) determined the following criteria that an occupation should comply with knowledge, relevance to the basic social values ​​of the community, length of the education, rendering of services to the public, autonomy, sociability, professional ethics and commitment to the profession [19]. In line with the international literature [4,20], the professionalization process of nursing in Turkey has made significant improvements especially since the 1980s [19]. Today, the professionalization process of nursing in Turkey is still one of the most important endeavors nurse leaders are involved in [18].

Education is an important criterion in the process of professionalization. The establishment of the modern nursing in Turkey has been achieved since the foundation of the Republic of Turkey. Healthcare provided by Florence Nightingale for the wounded British soldiers during the Crimean War in Turkey (between 1854 and 1856) and her success played an important role in the development of nursing as a profession. The Red Crescent Nursery School, Turkey’s first national nursing school was opened in 1925 as a high school [21]. Nursing schools providing education for junior high school graduates and conferring diploma on the graduates were opened in 1946 by the Ministry of Health. The first undergraduate nursing school was opened in 1955 at Ege University. Shortly after the start of undergraduate education in nursing, nursing schools offering postgraduate education or doctoral programs were opened in 1968 and 1972 respectively [21,22]. After the diploma-based and associate of science-degree nursery programs were closed in 1996, 76 Vocational School of Health Services offering undergraduate education were opened nationwide [22]. Finally, in 2007, the nursing law was changed and the new law required that the basic nursing education should be given at the undergraduate level [18]. However, due to the great need for nurses in the country, it was decided to continue some of the diploma-based programs. In recent years, some undergraduate nursing schools have been converted to nursing faculties. Nursing education in Turkey is currently being carried out mainly at the undergraduate level. Consequently, it can be said that there have been significant advances in nursing education in Turkey over the years.

Another important indicator of professionalism is the presence of professional organizations. Turkish Nurses Association, a national nursing organization, was founded in 1933, and it became a member of the International Council of Nurses (ICN) in 1949. Currently, the association has approximately 14.000 members [23]. However, this number can be considered rather insufficient given the number of nurses in our country is close to 100.000. In addition, there are approximately 25 nursing associations in different fields of nursing. However, the number of the members of these associations is not at the desired level either [24,25].

The law of occupation is another important professional criterion. In Turkey, the nursing law was first enacted in 1954. It was revised in 2007 since it failed to meet the needs [22]. In the revised law, nursing education was required to be given at the undergraduate level, gender discrimination was eliminated, and specialization in nursing was identified. In 2010, job descriptions, roles and responsibilities of nurses who would work as a manager, general duty nurse or clinical nurse specialist were defined with regulations [22,23]. In addition, in recent years, issues such as continuous nursing education, post-graduate certificate programs and encouraging nurses to participate in research have gained importance [18].

With the start of master’s and doctoral programs in Turkey, the number of studies contributing to the steady accumulation of professional knowledge has increased. Therefore, today, there are more than 20 scientific and professional nursing journals published by the nursing schools, professional associations and other organizations [25,26]. The Journal of Turkish Nurses, first published in 1953, is the first nursing magazine in Turkey.

Professional autonomy is another professionalization criterion. Nursing autonomy is defined as competence in making nursing decisions for the care of a patient and being independent while performing nursing practices [27]. In our country, despite the increase in the number of well-educated nurses, nurses cannot fully use their autonomy in the present health care system. Those who have a voice in health services are physicians, and the notion that nurses are auxiliary staff has not been eliminated yet. Several studies on the issue have determined that nurses in our country cannot demonstrate their professional autonomy truly [14,27].

Another important criterion in the process of professionalization is commitment to the profession. In order for an occupation to be carried out by its members effectively and to advance in the process of professionalization, it needs members who internalize their professional identity and greatly commit themselves to the profession [19,28]. If an occupation is internalized by its members, then it is welcomed by the community as well [28]. Hwang et al., (2009) state that it is possible to achieve professionalism by developing the professional identity. In a study conducted in Turkey, professional qualifications of nurses were found to be low [14].

Another criterion of professionalism is to render essential services to the public. It can be said that the public image of the nursing profession and the public’s perception of the nursing profession are of great importance in the professionalization process of nursing Turkish [29,30] and international nursing literatures [5,31], indicate that although the public image of nursing profession and nurses is more positive than it was in the past, it still has not improved adequately. Several studies of various groups in society (public, physicians, students) conducted in the 2000s in Turkey have revealed that nurses are perceived as people who assist a physician, give an injection or measure blood pressure and that the nursing profession is perceived as a low status profession with difficult working conditions [32,33]. It can be said that the public’s negative perception of nurses and nursing profession in Turkey may negatively affect young people’s intentions of preferring nursing profession as a career. In practice, the status of nursing as a profession is not at the desired level. The health system in Turkey is mainly based on hospital treatment services, and almost all of the nurses’ work in hospitals. In this system, nurses, in general, work “task-centric”. In the health care system, physicians have the leading role, and thus nurses are often unable to perform their healthcare functions independently of physicians [27]. On the other hand, salaries paid to nurses by private hospitals in Turkey, the number of which is rapidly increasing, are rather low. In Turkey, the distribution of healthcare workers across the country is not balanced. While a large number of nurses are employed in big cities and in the western part of the country, the number of nurses employed in the eastern and central parts of the country is insufficient. According to the data released by the Ministry of Health in 2010, the number of nurses per 1,000 people is 1.56 [34]. Due to shortage of nurses, nurses are generally obligated to work overtime. Job satisfaction [35,36] and burnout levels of nurses [37] in Turkey are moderate. Most of the nurses who work actively in nursing have an associate’s degree [14].

Methods

All the data were coded and entered in the Microsoft excel 2013 and all the entries were checked for any errors. SPSS 16 and STATA 12.1 were used for statistical analysis. Data were analysed using descriptive and inferential statistics. Descriptive statistics used were frequencies, percentage, mean, standard deviation and range and inferential statistics included were Chi-square test, Fisher exact test, Paired t test, Repeat measures ANOVA and Mann Whitney U-test. The p-value of <0.05 was taken as statistically significant.

Design and sample

The study was conducted as a descriptive and cross-sectional study. The study population consisted of nurses working in hospitals in Turkey. The number of nurses working in hospitals is approximately 55.000 [34]. For the sample selection, the stratified sampling method was used. Turkey was divided into seven geographical regions, and then the number of nurses working in each region was determined. For the determination of the desired sample size, the values considered significant were as follows: alpha=0.05 and d = F 1. The sample included 2365 nurses from the seven regions. Using the simple random sampling method, two university and two state hospitals from each region were selected, and thus nurses working in 14 university and 14 state hospitals were included in the sample. Of the 2365 nurses in the sample, 112 were excluded from the study since they did not fill out the forms correctly. Therefore, the study was completed with 2253 nurses (the participation rate of the sample is 95.3%, and the percentage of the population represented in the sample is 4.1%).

Data collection tool

The data were collected with a questionnaire developed by the researchers using the literature [5,38].

The questionnaire: The questionnaire consists of four sections. The first part of the questionnaire comprises five questions about the nurses’ demographic characteristics (age, gender, education). The second part includes three questions on nurses’ work characteristics (the institution they work in, working hours and occupation). The third section consists of 11 questions about the nurses’ opinions related to their profession and commitment to the profession. The fourth part includes four questions prepared to determine the nurses’ status regarding their participation in scientific activities and memberships in any association. The questionnaire contained close-ended and multiple-choice questions. Expert opinions of three academics were obtained with regards to content validity. The validity and comprehensibility of the questionnaire was tested in a pilot study with a sample group of 30 nurses. During the pilot study, content validity of the questionnaire was investigated, and similar questions were excluded. Questions in the questionnaire comprise the basic variables studied. In addition, the questionnaire were administered to the nurses three weeks later using the test-retest method, and the response ratio between the two applications (response rate of the first application / response rate of the second application) was found to be 0.92 [39]. All ambiguities were corrected before the administration of the questionnaire to the final sample. The evaluation of their results indicated no problems in terms of the clarity and the implementation of the form.

Data collection procedure

To fill out the questionnaires, 28 interviewers (one from each of the hospitals included in the sampling) were employed. Interviewers were chosen from university students studying in the field of health. Prior to the application, an informational meeting on the implementation of the study was held with the interviewers. Before the application, the interviewers met with the hospital’s head nurse in each hospital to inform them about the study, and upon the approval of the head nurse, they interviewed nurses in the clinics. Data collection forms were distributed to the nurses by the interviewers after one-to-one interviews. The interviewers explained the purpose and importance of the study to the nurses, and the nurses who agreed to participate in the study filled in the forms themselves. Nurses were asked not to place their names on the form. The forms were collected on the same day. It took about 20-25 minutes to fill in the form.

Data analysis

For the evaluation of the data, SPSS 14.0 package program was used. For the statistical analysis of the data, percentages, the chi square and multiple logistic regression analysis test were used.

Ethical approval

This study was reviewed and approved by the research ethics committee of the author’s institution (Decision no: 83116987-051). Before the data were collected, the written permissions of the institutions where the nurses worked were obtained. In addition, verbal consents of the nurses participating in the study were obtained after the purpose of the study was explained to them. The study was conducted according to the Declaration of Helsinki.

Results

Demographic characteristics

The mean age of the nurses was 31.51 ± 6.10. Of the nurses, 50.2% were in the 20-30 age group, 41.9% in the 31-40 age group, and only 7.9% in the 41 and over age group. Of the nurses, 96.1% were female, 34% had undergraduate education, and 2.3% had the master’s degree. Their mean length of service was 10.14 ± 7.19 years. While 42.4% of the nurses had been working for 11 years and over, 26.4% of them had been working for 2-5 years. Whereas 83% of the nurses were working as a clinical nurse, only 0.8% of them were working as a nurse specialist.

The nurses’ commitment to their profession and their views on nursing

Table 1 shows nurses’ commitment to the profession and their opinion about the profession. Of the nurses, 62.3% chose the nursing profession willingly, 43.5% chose it due to employment opportunities, 59.3% stated that they might change their jobs in case they were offered better job opportunities, 15.4% considered leaving their profession, 51% were satisfied with the profession, 19.4% expressed their dissatisfaction and 40.6% would not have chosen the nursing profession if they had another chance to choose a career.

Of the nurses, 75% considered the nursing profession as an appropriate profession for themselves, 25% stated the opposite, a great majority (83.9%) were proud of being a nurse, a small number (6.7%) were not comfortable about this issue, 69% considered nursing as a profession essential for public health, 36.6% said that they would suggest other people to involve in nursing as a profession and 41.5% said that they would not.

When the nurses’ opinions about nursing and about whether they chose it willingly were compared (Table 2) it was determined those who chose the profession willingly considered leaving or changing their profession significantly less than those who did not (p<0.01). The number of the nurses who stated that they were satisfied with the profession and would choose it again was significantly higher among those who chose the profession willingly than among those who did not (p<0.01). In addition, the number of the nurses who considered nursing is suitable for them, who would suggest it to others, who would not mind saying they were nurses and who regarded nursing as an essential profession for public health was significantly higher in those who chose the profession willingly than in those who did not (p<0.01).

The number of the postgraduate nurses who considered nursing is suitable for them, who were optimistic about the future of the profession, who would recommend it to others and who would choose the nursing again was significantly higher than that of the other nurses (p<0.01). The undergraduate nurses’ desire to change the profession was significantly lower whereas their tendency to recommend the profession to others and to choose the profession again was significantly higher (p<0.01).

According to the results of multiple logistic regression analysis, those who chose the profession willingly were 7.91 times more likely to choose it in order to provide care for people, 7.33 times more likely to be satisfied with their profession, 0.59 times less likely to change their profession, 3.04 times more likely to consider nursing as a suitable career for themselves, 1.54 times more likely to comfortably tell others that they were nurses and 1.77 more likely to suggest nursing as a profession to others than were those who did not choose the profession willingly (Table 3).

Nurses’ participation in professional activities

In order to improve their professional skills, of the nurses, 39.4% participated in training courses, 37.2% participated in congresses and 27.7% kept up with professional journals. On the other hand, it was determined that of the nurses, 60.6% did not participate in training courses, 36.5% did not attend professional conferences, and 72.3% did not keep up with professional journals. In addition, while 32.3% of the nurses stated that they were the members of a national professional organization, 67.7% stated that they were not the members of any association (Table 4).

It was determined that the undergraduate and graduate nurses participated in professional courses and conferences, kept up with publications and became members of professional association more than did the associate degree graduates, and the difference was significantly high (p<0.001). The nurses who had 0-1-year work experience participated in professional conferences and kept up with publications more than did the others (p<0.001). The nurses who had worked 11 or more years or were over age 41 followed the publication less than did the others (p<0.001). Charge nurses and head nurses participated in professional courses and conferences, kept up with publications and became members of professional association more than did the other nurses, and the difference was significantly high (p<0.001). (Table 5).

According to the results of the logistic regression analysis, of the nurses, those who had an undergraduate or graduate degree, those who were charge nurses or head nurses, and those who did not want to leave the profession applied for membership of professional associations more. Of the nurses, those whose length of service was 0-1 years, those who chose the profession to provide care to people and those who considered nursing as a suitable career for themselves attended vocational courses more. Finally, of the nurses, those who had an undergraduate or graduate degree, those who chose the profession willingly and those who considered nursing as a suitable career for themselves kept up with professional journals and publications more than did the others.

Discussion

Demographic characteristics

Views of the members of the nursing profession give important clues to the evaluation of the status of nursing in the professionalization process. It was determined that most of the nurses were in the 20-30 age group, and that the number of the nurses in the 40 and over age group was low. The findings of our study were similar to those of a previous study conducted [14], on the same topic. This finding supports the data that nurses leave their profession at a young age, and is similar to the findings of other studies conducted [40,41], across the world on the shortage of nurses. The study determined that, of the nurses who were actively working, 34% had undergraduate education and only 2.3% had post-graduate education. According to this result, it can be said that the education level of the nurses working in Turkey is still insufficient for a professional job. In this study, the number of specialist nurses who were actively working was rather insufficient. This may be explained with the fact that specialization in nursing in Turkey is quite a new phenomenon which was first introduced in the nursing law revised in 2007. As in other countries, the vast majority of the nurses working in Turkey are female. Only 3.9% of the nurses in this study were male. In Turkey, male students have been enrolled in nursing schools since 1995. At present, approximately one third of the students attending nursing schools are male.

The nurses’ commitment to their profession and their views on nursing

In our study, more than half of the nurses indicated that they chose the profession willingly. A similar study [42], carried out in Turkey in recent years support this finding. This finding may suggest that the nursing profession is now recognized as a career more and that it is advancing in its way to become a profession preferred more. In the international literature, among the reasons why nurses choose nursing as a profession are that nursing has social and humanitarian aspects, that they want to help others, and that nursing has the potential to contribute to the society [43,44]. However, in this study, whereas only one-fifth of the nurses stated that they chose the nursing because they wanted to provide healthcare for people, nearly half of them stated that they chose it due to employment opportunities. According to the studies by Aktas et al. [45], Unsal, Yıldırım, & Aymelek. [42] and Varaei et al. [4], advantages such as “no risk of being unemployed” and “making good money” took the first place among the reasons why students chose nursing. This finding suggests that nurses in our country generally choose the nursing profession for economic reasons.

In line with the study [46], conducted in Turkey in previous years, this present study indicated that half of the nurses were satisfied with their profession. When the fact that nurses’ job satisfaction level influences the quality of care they provide is taken into consideration, this result can be regarded as positive. On the other hand, half of the nurses stated that they were satisfied with the profession very little or not at all. The health system in Turkey is mainly based on treatment services provided in hospitals, and in this system, almost all of the nurses work “task-centric” and thus they are inadequate in “primary care” and “evidence-based care” applications. In health services, physicians have the leading role, and thus nurses cannot perform their healthcare functions independently. On the other hand, in many institutions, nurses’ salaries are low. It can be said that all these conditions affect nurses’ professional satisfaction, which should be taken into account by the nurse managers while assessing the quality of health care, and services and the factors leading to dissatisfaction.

The nurses’ inclinations to change their profession were high but to leave their profession were low, which is in line with the findings of the studies conducted by Varaei et al. [4], in Iran and by Korkmaz & Gorgulu [19], in Turkey. This can be interpreted as nurses achieve their jobs unwillingly or they perceive nursing not as a profession but as a task they are supposed to carry out in order to earn their livings. Nearly half of the nurses stated that they would not choose nursing as a profession again whereas one-quarter of them stated they were undecided whether to choose the profession again. The findings of the studies conducted by Karamanoglu et al. [46], in Turkey and by Siebens et al. [40], in Belgium support the findings of this study. However, 90.5% of the nurses in the study conducted by Sharbaugh [38], in the U.S.A. and 78.2% of the nurses in Milisen et al. [43], study conducted in Belgium stated that they would choose nursing as a profession again. When Turkey is compared with other countries, it can be said that in Turkey, nursing is less preferred and nurses’ working conditions and professional personal rights are not satisfactory.

More than half of the nurses in the study considered nursing profession as a decent career for themselves. Additionally, the majority of the nurses in the study perceived nursing as an essential profession, did not mind telling other people that they were nurses and would have talks with other people about nursing. These findings are important indicators in that nurses internalize their professional identity more positively. The more a person identifies himself/herself with the profession, the more he/she can strive for the development of the profession. Therefore, it can be said that Turkish nurses achieved important developments related to professional commitment. However, for one-quarter of the nurses, nursing profession was not a decent career for them. This finding is important and should be taken into account because it indicates that nurses experience problems related to their professional identity.

In this study, almost half of the nurses stated that they would not advise other people to choose nursing as a career, which is similar to the findings of studies conducted by AMN Healthcare, Inc. [47] and by Varaei et al. [4], in Iran. However, 92.7% of the nurses in the study conducted by Sharbaugh [38], in the U.S.A. and 83.4% of the nurses in Milisen et al., [43] study conducted in Belgium stated that they would recommend other people to choose nursing as a career. Consequently, it can be suggested that both the members of the nursing profession and the government should take initiative to make the nursing profession more appealing. Thus, shortage of nurses in Turkey is one of the most important problems in the field of health today, which indicates that it is an issue to be tackled by the government (ministry of health, etc.).

The nurses who chose the profession willingly and/or had higher levels of education displayed more positive attitudes to their profession than did the nurses who did not choose the profession willingly and/or had lower levels of education, and the difference between them was statistically significant. According to the results of logistic regression analysis, opinions of the nurses who chose the profession willingly about the profession were more positive and they internalized the profession more. This is a positive finding. Positive perceptions of the members of a profession regarding the profession and their commitment to the profession contribute to the professionalization of the career. This result indicates that it is of great importance to take measures so that the nursing profession should be chosen consciously, that it should be familiarized more so that it is chosen consciously and that nursing education should be at least at the undergraduate level. Sharbaugh [38], determined that professional commitment, job satisfaction and professional identity levels of nurses who stated “I can choose the nursing profession again.”, and “I would recommend it to others as a profession.” were significantly higher. In this sense, it is important to facilitate public awareness of nursing, to promote the image of the nursing profession in public and to encourage people to choose nursing as a profession.

Nurses’ participation in professional activities

Evaluation of the nurses’ professional performance revealed that most of the nurses were not the members of national nurses association. However, the proportion of the members in this study (32.3%) was significantly higher than that in a previously conducted study [19]. In addition, in many studies, it has been pointed out that the awareness of building professional organization among nurses is low [24,25,48]. That the number of nurses who are the members of professional associations is limited might be due to the fact that membership is not mandatory. In line with this result, it can be said that in our country, nurses’ awareness of building professional organizations is not at a desired level. Among the nurses, the rate of keeping up with publication on nursing and participating in vocational courses and congresses is low. Previously studies support this finding too [46,49]. The result might be due the fact that nurses working in the field of healthcare are mostly associate-degree graduates. Traditionally, nurses in Turkey still cannot work independently of physicians. On the other hand, although the nursing law and regulations in our country were revised a short while ago in order to highlight nurses’ primary care giver role and the need for evidence-based nursing practices, they have not been put into practice yet.

In line with the findings of other studies [18,50], the findings of this study revealed that the nurses having bachelor’s or master’s degrees participated in professional activities more than did the others having associate’s or undergraduate degrees, and the difference was significantly high. This indicates that as the nurses’ level of education increases, so do their interests in occupational activities. This result also reveals the necessity that, for the professionalization of the nursing profession, nursing education should be at least at the undergraduate level. The rate of participating in professional conferences and keeping up with publications was higher in nurses who had 0-1 year of work experience than in other nurses. Nurses’ willingness to participate in professional conferences and to keep up with publications is inversely proportional to the length of their work experience. This finding is compatible with the finding of Hisar & Karadag’s study [18]. The rate of following publication was lower among the nurses who had 11 or more years of work experience, or who were over age 41. If experience and age are important factors in the positive development of nurses’ professional identity, then the professional identity development of the nurses in the study group can be said to be insufficient. The rate of participating in professional conferences and keeping up with publications is higher in charge nurses and head nurses than in clinical nurses. Nurses working as a charge nurse in hospitals in Turkey always work during daytime and have administrative responsibilities. Clinical nurses are directly responsible for patient care and they work in shifts. Therefore, nurses’ interest in participating in professional conferences and keeping up with publications may be related to nurses’ working conditions and expectations. Excessive workload, long working hours and shortage of resources allocated to nurses are among the factors preventing nurses from developing professional behavior. This finding is compatible with the findings of Hisar & Karadag’s study [18]. According to the results of the logistic regression analysis, of the nurses, those with higher level of education, holding responsible positions at work, having chosen the profession willingly, having positive perceptions of the profession, internalizing the profession and considering nursing suitable for themselves were more frequently engaged in professional activities such as association membership, professional participation in vocational courses and keeping up with professional publications. These findings for the professionalization of nursing; education at the undergraduate level is, the profession and the importance of informed choices in the process of training students to develop their professional identity is an important finding showing that weight should be given.

Strengths and limitations of the study

One of the strengths of this study is that it was conducted with the participation of nurses across Turkey. The second one is its large sample size. The first limitation of the study is that the data collection form is based on nurses’ own statements. The second one is the sample includes only the nurses working in hospitals.

Conclusions and Recommendations

Based on the results of this profile study conducted in Turkey, it can be said that although there has been improvement in nurses’ professional satisfaction and professional performance levels in recent years compared to previous years, the improvement is not satisfactory. Most of the nurses were satisfied with the profession and considered their profession as a decent one for themselves. The nurses chose the profession willingly and preferred it due to employment opportunities. The nurses wanted to change their profession very much, but not at present. The majority of the nurses considered nursing as essential for public health. However, half of them would not recommend others to choose nursing as a profession. The nurses who had bachelor’s or master’s degrees or who chose the profession willingly had more positive opinions about the profession and higher levels of commitment to the profession than did nurses who had an associate’s degree or who did not choose the profession willingly, and difference was significant Choosing the profession willingly positively affects opinions about the profession and facilitates the development of professional identity. In order to increase students’ conscious choice of the nursing profession, it may be recommended that students should be informed of nursing profession, that public awareness of nursing profession should be raised via nursing associations and that the public image of the profession should be promoted.

In the study, the nurses’ participation in professional activities was determined to be generally inadequate. More than half of the nurses neither kept up with publications on nursing nor joined activities such as courses, conferences, etc. nor became members of nursing organizations. This is especially true for diploma and associate degree nurses, clinical nurses, and nurses in advanced age. Therefore, it is recommended that institutions should encourage elderly nurses and clinical nurses with a lower level of education to develop their professional performance, provide training on raising awareness, motivate nurses to join occupational activities and develop institutional policies accordingly. In addition, in order to increase the number of the members of nursing associations, membership to the national nurses association should be compulsory and attempts to build a united nurses association should be accomplished. Since participation in professional activities is directly related to the level of education, it is recommended to continue and conclude nationwide endeavors aiming at giving nursing education at least at an undergraduate level.

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